instruction stringclasses 1 value | input stringlengths 6 8.98k | output stringlengths 5 3.11k |
|---|---|---|
Generate impression based on findings. | 77-year-old male with history of duodenal stenosis on past endoscopy and history of pyloric ulcer for evaluation of outlet obstruction. Double contrast visualization of the esophagus showed no morphologic abnormalities of the mucosal surfaces or mural contours. During the exam, no spontaneous or provoked gastroesophageal reflux was observed.The stomach was normal in size, shape, and position. Spontaneous emptying of contrast into the duodenal sweep was observed. The gastric mucosal surface was normal.The duodenal bulb and sweep were within normal limits. A 1.0 x 1.4 cm diverticulum was noted arising from the 3rd portion of the duodenum with a 4 mm neck. TOTAL FLUOROSCOPY TIME: 5:33 minutes | 1.Duodenal diverticulum as described above.2.No evidence of outlet obstruction or duodenal stenosis. |
Generate impression based on findings. | The patient submitted outside mammogram dated 12/5/2012, from HealthEast Health Care System. Submitted outside study was compared to the current mammogram dated 1/19/2015. The breast parenchyma is almost entirely fatty. Previously identified focal asymmetry in the right superior breast is stable when compared to the prior exam. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. Postsurgical changes, including coarse dystrophic calcifications in the right breast, are compatible with bilateral breast reduction. There are no new suspicious microcalcifications or areas of architectural distortion.There is no significant change between these two studies. | Stable focal asymmetry in the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually, due next in Jan 2016.BIRADS: 2 - Benign finding.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | 15 year-old male with abdominal pain and vomiting. Evaluate for necrotizing pancreatitis. ABDOMEN:LUNG BASES: Lung bases are normal with no evidence of focal pulmonary opacities or pleural effusion. LIVER, BILIARY TRACT: Liver is enlarged measuring up to 27.9 cm in craniocaudal dimension. Diffuse decreased density of the liver compatible with fatty infiltration.SPLEEN: Spleen is enlarged measuring up to 14.7 cm in length.PANCREAS: Pancreas is enlarged measuring up to 4.4 cm in axial dimension. Normal enhancement of the pancreatic parenchyma with no evidence of necrotic pancreatic tissue. Extensive peripancreatic soft tissue stranding (Series 3, Image 69 and 76) as well as mild abdominal and pelvic ascites with no evidence of loculated fluid collection or abscess. Surrounding arteries and veins are patent with no evidence of thrombus or aneurysm. ADRENAL GLANDS: Adrenal glands are normal.KIDNEYS, URETERS: Kidneys are normal in appearance with no evidence of hydronephrosis. RETROPERITONEUM, LYMPH NODES: Mildly prominent mesenteric lymph nodes in the upper abdomen.BOWEL, MESENTERY: Bowel is normal in caliber with no evidence of obstruction. BONES, SOFT TISSUES: No evidence of fracture or dislocation. Soft tissues are normal.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal caliber with no evidence of obstruction. BONES, SOFT TISSUES: No evidence of fracture or dislocation. Soft tissues are normal.OTHER: No significant abnormality noted | 1. Findings compatible with acute pancreatitis with no evidence of necrosis. Mild abdominal and pelvic ascites with no evidence of loculated fluid collection or abscess. 2. Hepatic steatosis and hepatosplenomegaly. Findings were discussed with Dr. Krishna Siruguppa on 2/13/2015 at 1:30 PM. |
Generate impression based on findings. | Lung cancer. 15 months after right upper lobectomy for stage I NSCLC. LUNGS AND PLEURA: Post-surgical changes and volume loss from right upper lobectomy, unchanged. Large thin-walled subpleural cyst at the right apex, unchanged.Left lower lobe 5-mm nodule (series 5, image 84), progressively increasing in size over multiple prior CTs (2 mm on 8/2013), suspicious for a synchronous primary malignancy and much less likely a metastasis. No other suspicious pulmonary nodules.Left apical fibrosis, unchanged.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Surgical clips in the right hilum.Severe coronary artery calcification. Normal heart size without pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Left renal cyst. Abdominal aorta atherosclerotic calcification. | Slowly enlarging left upper lobe 5-mm nodule is suspicious for an indolent primary lung malignancy and much less likely a metastasis. |
Generate impression based on findings. | The patient submitted outside mammogram dated 3/7/2012, from Mercy Hospital. Submitted outside study was compared to the current mammogram dated 1/9/2015. The breast parenchyma is composed of scattered fibroglandular density. No suspicious masses, microcalcifications or areas of architectural distortion are present. There is no significant change between these two studies. | No mammographic evidence of malignancy. Physical examination is of increased importance for a patient with dense breast. 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. | The patient submitted outside mammogram dated 3/7/2012, from Mercy Hospital. Submitted outside study was compared to the current mammogram dated 1/9/2015. The breast parenchyma is composed of scattered fibroglandular density. No suspicious masses, microcalcifications or areas of architectural distortion are present. There is no significant change between these two studies. | No mammographic evidence of malignancy. Physical examination is of increased importance for a patient with dense breast. 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. | Reason: ho tongue ca, s/p CRT, compare to previous. measurements pls History: none CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses.Basilar subsegmental atelectasis. Focal airspace consolidation. No pleural effusions.Mild centrilobular emphysema. MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. Moderate coronary artery calcifications.Mildly prominent mediastinal and retrocrural lymph nodes appear stable.Reference right paratracheal lymph node measures 13 x 10 mm (series 3, image 33), unchanged.Diffuse esophageal wall thickening, stable.CHEST WALL: Right chest port, tip in the SVC.Mild degenerative disease of the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Retroaortic left renal vein, normal anatomic variant. Scattered small hypodensities, likely cysts. Left renal scarring.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Gastrostomy tube in place.BONES, SOFT TISSUES: Degenerative disease of the lumbar spine.OTHER: No significant abnormality noted. | Unchanged intrathoracic lymph nodes without definitive evidence of metastatic disease. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Family history of breast cancer in paternal grandmother. 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. A circumscribed mass is seen in the right breast at the 6 o'clock position, unchanged from prior examinations and compatible with cyst. 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: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | 40 year-old female with history of DRUJ instability, evaluate for interval changeVIEWS: Left wrist, PA and lateral (two views) 2/13/15 11:27 Interval removal of cast. There is mild positive ulnar variance, but no fracture or other underlying osseous abnormality. | Mild positive ulnar variance without other abnormality to explain the patient's pain. |
Generate impression based on findings. | GE Junction esophageal cancer please compare to prior PET/CT per CALGB 80803. RADIOPHARMACEUTICAL: 12.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 178 mg/dL. Today's CT portion grossly demonstrates a right chest port with tip in the SVC. Extensive atherosclerotic disease is present including coronary arterial calcifications. Diffuse fatty infiltration of the liver is noted. Hypodense bilateral renal lesions are noted, likely representing cysts. Today's PET examination demonstrates diffuse muscle activity suggestive of altered biodistribution such as a non-fasting state. There has been complete interval resolution of the abnormal distal esophageal activity without suspicious FDG avid activity currently. No new or additional suspicious FDG avid lesion is identified elsewhere in the neck, chest, abdomen or pelvis. | Complete interval resolution of the abnormal distal esophageal activity without suspicious FDG avid lesion to indicate tumor activity currently in the neck, chest, abdomen or pelvis. |
Generate impression based on findings. | The patient submitted outside mammograms dated 4/15/2014 and 3/5/2013, from Stroger Hospital. Submitted outside studies were compared to the current mammogram dated 1/12/2015. The breast parenchyma is composed of scattered fibroglandular density. Prior mammograms demonstrate stable architectural distortion, increased density and minimal skin retraction in the left upper outer breast, all presumably related to prior left lumpectomy. Surgical clips are also identified in the left axilla. A benign morphology mass in the left medial breast is also stable when compared to prior exams. There is no new suspicious mass, microcalcifications or areas of architectural distortion present in either breast. There is no significant change between these two studies. | Stable postsurgical changes of the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine diagnostic mammogram is recommended annually, do next in January 2016.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 9-year-old male with acute lymphoblastic leukemia on chemotherapy, including steroids. Bilateral foot pain. Evaluate for AVN.VIEWS: Right and left foot AP, oblique, lateral. Right and left ankle AP, oblique, lateral (12 views) 2/13/2015 12:08 No evidence of fracture, dislocation or findings to suggest avascular necrosis. No soft tissue swelling. Normal alignment. | Normal examination. |
Generate impression based on findings. | History of auto stem cell transplant and DLBCL. Post auto SCT evaluation.RADIOPHARMACEUTICAL: 13.2 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 93 mg/dL. Today's CT portion grossly demonstrates a 10 mm right intraparotid lymph node as well as scattered subcentimeter bilateral jugular lymph nodes. A right chest port catheter tip is in the right atrium. A prominent prevascular lymph node is not significantly changed in size. A previously described left para-aortic lymph node is also similar to the prior study. There are additional scattered subcentimeter retroperitoneal and mesenteric lymph nodes. There are coronary artery calcifications. Left inguinal surgical clips are noted. Today's PET examination demonstrates several small jugular and right intraparotid station mild to moderately hypermetabolic lymph nodes, most notably a left posterior jugular node (max SUV of 6.0), which are new from the prior examination. While these may be seen with inflammation, tumor progression cannot be excluded. A subcentimeter celiac lymph node with a max SUV of 3.8 is new from the previous study; this may also be inflammatory in etiology, however, tumor cannot be excluded. No additional FDG avid focus is identified. | Several subcentimeter mild to moderately hypermetabolic lymph nodes in the neck, most notably in the left posterior jugular station, are new from the prior examination. These may be inflammatory, however, tumor cannot be entirely excluded. Attention to these areas on physical examination and follow up imaging can be made. |
Generate impression based on findings. | 3-year-old male with brachial plexus palsyVIEWS: Right shoulder, AP, neutral, Grashey, axillary (4 views) 2/13/15 12:30 The humeral head is well directed towards the glenoid cavity, which is shallow in appearance, similar to the prior exam. Normal variant fragmentation of the humeral epiphysis is noted with slight broadening of the humeral neck. | Normal alignment with unchanged findings consistent with prior brachial plexus injury. |
Generate impression based on findings. | RCC and recent right clavicle fracture. There is moderately increased activity within the right medial clavicle consistent with fracture and/or possibly an underlying pathologic lesion. Subtle focus of decreased activity is noted within the right sternum which corresponds to a lytic lesion seen on CT. This may represent a small metastasis but this is equivocal given its small size. A left ninth rib lesion corresponds with a nonspecific but probable benign lesion seen on CT. A compression fracture of the L1 vertebral body demonstrates no abnormal increased activity and there is no evidence of a pathologic lesion on CT. Distortion of the left kidney activity represents the patient's known renal cell carcinoma. | 1.Abnormal osteoblastic activity in the medial right clavicle consistent with fracture and possible underlying pathologic lesion.2.Very subtle decreased sternal focus with small lytic CT correlate could represent a small lytic metastasis but this is equivocal.3.No definite osseous metastases otherwise. Consider a PET/CT for further evaluation of possible soft tissue and osseous metastatic disease. |
Generate impression based on findings. | Patient is a runner. Pain over second and third metatarsals. Mild soft tissue swelling involving the fifth toe with small punctate calcification or metallic fragment observed in the infralateral aspect. The remainder of the foot other than mild angulation deformity of the second toe, presumably a remote, only demonstrates minimal are asked reaction of the second metatarsal, presumably a minimal stress reaction. No discrete acute process or fracture. | Stress reaction of the second metatarsal with questionable soft tissue swelling of the right fifth toe |
Generate impression based on findings. | The patient submitted outside mammograms dated 4/15/2014 and 3/5/2013, from Stroger Hospital. Submitted outside studies were compared to the current mammogram dated 1/12/2015. The breast parenchyma is composed of scattered fibroglandular density. Prior mammograms demonstrate stable architectural distortion, increased density and minimal skin retraction in the left upper outer breast, all presumably related to prior left lumpectomy. Surgical clips are also identified in the left axilla. A benign morphology mass in the left medial breast is also stable when compared to prior exams. There is no new suspicious mass, microcalcifications or areas of architectural distortion present in either breast. There is no significant change between these two studies. | Stable postsurgical changes of the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine diagnostic mammogram is recommended annually, do next in January 2016.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
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 almost entirely fatty, 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: NSA - Screening Mammogram. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are digital mammographic images (1/26/15), ultrasound images of left breast (1/26/15), images from ultrasound guided biopsy and post-procedural left mammographic images (1/27/15) performed at Aspen Valley Hospital. For comparison, digital mammographic images (7/29/13), ultrasound images (7/29/13) are available. DIGITAL MAMMOGRAPHIC IMAGES (1/26/15):The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. There is a stable round 2 cm mass, which is a cyst, at posterior upper outer quadrant in the left breast.Just anterior to this mass, there is an irregularly shaped focal asymmetry, measuring 2 cm, associated with cluster of amorphic calcifications.Stable round mass is present at upper outer quadrant in the right breast.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in right breast. ULTRASOUND IMAGES OF LEFT BREAST (1/26/15):An irregularly shaped hypoechoic mass, measuring 18 x 7 x 16 mm, is visualized at 3 o'clock position in the left breast. This mass corresponds to the irregularly shaped mass on mammograms. Stable simple cyst is present just next to this mass. Multiple small cysts are present at 4 o'clock position. A few normal appearing lymph nodes are detected in left axilla.IMAGES FROM ULTRASOUND GUIDED BIOPSY AND POST-PROCEDURAL LEFT MAMMOGRAPHIC IMAGES (1/27/15):Ultrasound guided biopsy was performed for the left breast mass at 3 o'clock position, with appropriate needle placement. The cyst next to the mass appears to be ruptured with this procedure. Post-procedural left mammographic images revealed that a marker clip is placed at anterior aspect of the target mass.Per outside report, the pathology result of this biopsy was malignant; infiltrating ductal carcinoma grade 3 with high nuclear grade ductal carcinoma in situ. | Biopsy proven carcinoma in the left breast. In view of ill-defined appearance of the carcinoma on mammogram, breast MRI might be useful for evaluation of disease extent.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Check for healing proximal humerus fracture Interval healing with interval callus formation observed involving the comminuted right proximal humeral head fracture. No evidence of change in alignment. | Healing comminuted humeral head fracture |
Generate impression based on findings. | Ms. Butler is a 50 year old female with a family history of breast cancer in her mother. She has no current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Benign intramammary lymph node identified in the left superior breast. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Left foot pain Persistent minimally overlapping oblique distal left metatarsal fracture without evidence of significant interval change. Decreased soft tissue swelling and the remainder of the foot remains otherwise unremarkable | Oblique distal fifth metatarsal fracture |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts along with an additional left MLO view 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. There are 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. | There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is minimal periventricular and subcortical white matter hypoattenuation which is nonspecific, but likely representing mild age indeterminate microvascular ischemic change. The ventricles and basal cisterns are prominent consistent with mild generalized volume loss. Volume loss includes the bilateral hippocampi. There is no midline shift or herniation. There is opacification of the left anterior and posterior ethmoid air cells. The mastoid air cells and remaining paranasal sinuses are clear. The skull and extracranial soft tissues are unremarkable. | 1. No intracranial mass or mass effect.2. Global parenchymal volume loss which appears appropriate for patient's age.3. Mild chronic small vessel ischemic changes. |
Generate impression based on findings. | Right-sided inferior subcostal pleuritic pain. Malignant melanoma. Evaluate for PE. PULMONARY ARTERIES: Acute pulmonary emboli in right lobar and segmental/subsegmental pulmonary arteries supplying the middle and lower lobes.LUNGS AND PLEURA: Right lower lobe subpleural ill-defined groundglass opacity consistent with a small infarct. Trace right pleural effusion.Scattered micronodules are stable, likely postinflammatory.MEDIASTINUM AND HILA: Moderate coronary artery calcification. No right heart strain.Right hilar lymphadenopathy with reference lymph node measuring 2.6 x 2.4 cm (series 7, image 134), unchanged.Small hiatal hernia.CHEST WALL: Bilateral axillary surgical clips. No axillary lymphadenopathy.Postsurgical changes of a left mastectomy with small postoperative seroma, unchanged.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Unchanged hepatic cysts. | Acute pulmonary emboli in right lobar and distal arterial branches with an associated small right lower lobe infarct.PULMONARY EMBOLISM: PE: Positive.Chronicity: Acute.Multiplicity: Multiple.Most Proximal: Lobar.RV Strain: Negative. |
Generate impression based on findings. | Left hip pain following fall Moderate osteoarthritic changes with preservation of femoral head shape. Sclerosis and bulky osteophytes are observed greater than super aspect. | Moderate left hip osteoarthritis |
Generate impression based on findings. | Pain, follow-up fracture Continued healing with interval increasing callous formation of the transverse proximal left fibular fracture | Partial interval healing of a proximal left fibular fracture |
Generate impression based on findings. | Right knee pain and back pain, specifically L3-4 Knee: Mild osteoarthritic changes greater than medial compartment without superimposed additional abnormalityL-spine: Mild osteoarthritic changes observed involving the upper lumbar levels with relative sparing of L3 distally. Alignment, vertebral body heights and foramina intact and patent. | Mild scattered degenerative changes |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of right breast cyst aspiration. 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. Scattered, benign appearing calcifications are noted and appear stable. 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. | 19 year-old male with history of hydrocephalus. Motion artifact limits evaluation. Again seen are biparietal ventricular shunt catheters with tips at the midline. The right shunt catheter tip appears to lie more posteriorly when compared prior, although we suspect that this is related to patient positioning. The ventricular system is collapsed. There is no evidence of gross acute intracranial hemorrhage or parenchymal edema. There is abnormal prominence of the CSF space in the pineal cistern and the expected area of the right occipital lobe with associated parenchymal distortion appearing similar to the prior study. There is no midline shift. The calvarium, paranasal sinuses, and mastoids are unchanged. | 1. Biparietal VP shunts with no significant ventricular enlargement.2. No acute intracranial hemorrhage. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of right breast biopsy approximately 20 years ago, benign. 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. Scar marker noted over the upper right breast. 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. | T1N0M0 grade 2 overall stage 1 cancer of the petiole of the epiglottis extending into the right false vocal cord, treated with XRT and surgery. There are post-treatment findings related to pharyngolaryngectomy with tracheostomy, voice prosthesis insertion, and neck dissection. There is no evidence of measurable tumor in the surgical bed or significant lymphadenopathy by size criteria. The remaining salivary glands and thyroid appear unchanged, including a right-side thyroid nodule. There is moderate left and mild right carotid bifurcation calcified plaque. The osseous structures are unchanged. There are several new subcentimeter nodules in the imaged portion of the right upper lung. | 1. Extensive post-treatment findings in the neck, without convincing evidence of measurable tumor recurrence.2. Several new subcentimeter nodules in the imaged portion of the right upper lung are nonspecific, but may represent metastases. Further evaluation via a dedicated chest CT may be useful. |
Generate impression based on findings. | Reason: 2008 right upper lobectomy for T1N0M0 stage IA adenocarcinoma History: surveillance CT LUNGS AND PLEURA: Stable surgical changes of a right upper lobe resection, with linear scarring along the resection margin. Subpleural scarring along the anterior margin of the right middle lobe appears slightly more nodular compared to recent prior exams, with a prominent nodular component measuring 10 x 7 mm (sagittal image 36; series 5, image 100) increased from the prior exam.A small left upper lobe ground glass nodule measures 4 mm (series 4, image 25), unchanged from the prior exam dated 02/2013.No additional new pulmonary nodules or masses are seen.Basilar subsegmental scarring/subsegmental atelectasis. No new focal air space consolidation.No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. Severe coronary artery calcifications.Scattered small mediastinal and hilar lymph nodes are stable.CHEST WALL: Degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Multiple hypodense liver lesions are again seen, incompletely evaluated on noncontrast imaging, but stable in appearance dating back to 2008.A previously reference round cystic lesion in the right hepatic lobe continues to decrease in size on noncontrast imaging. | 1. New/increased nodularity along anterior right middle lobe scarring. Recommend 3-6 month followup imaging in a high risk patient.2. A 4mm ground glass nodule in the left upper lobe is unchanged dating back 2 years, and likely represents AAH (atypical adenomatous hyperplasia) |
Generate impression based on findings. | Female 15 years old Reason: evaluate for scoliosis History: leg length discrepancyVIEWS: Thoracic and lumbar spine PA, upright 2/13/15 (one views) Vertebral body heights and disk spaces are maintained. Normal alignment of the thoracic and lumbar spine. No segmentation or fusion defects. | Normal examination. |
Generate impression based on findings. | 79-year-old female with history of CVA. There is a small area of hypoattenuation involving the gray matter in the lateral aspect of the left precentral gyrus. There is no evidence of acute intracranial hemorrhage. There is mild periventricular and subcortical hypoattenuation. No midline shift or mass effect. The basal cisterns are intact. The visualized paranasal sinuses and mastoid air cells are clear. The calvarium and soft tissues of the scalp are normal. | 1. Small area of hypoattenuation within the left precentral gyrus likely representing a small infarct of uncertain age but potentially late acute to subacute. If patient care warrants further imaging, an MRI may be obtained.2. Mild age indeterminate small vessel ischemic disease. |
Generate impression based on findings. | History of Hodgkin lymphoma, nodular sclerosis status post 4 cycles of ABVD chemotherapy in need of restaging.RADIOPHARMACEUTICAL: 12 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 101 mg/dL. Please see diagnostic CT reports for details of the neck, chest, abdomen, and pelvis.Today's PET examination demonstrates diffuse marrow uptake which likely represents benign marrow stimulation.A small but mild to moderately hypermetabolic right axillary lymph node, max SUV of 2.8, is considered more likely benign though tumor cannot be entirely excluded.A small ringlike area of mild activity within the anterior mediastinum, max SUV of 2.7, is also most likely related to inflammation post therapy. There is diffuse apical predominant mild to moderate hypermetabolic activity within the bilateral lungs, max SUV of 4.1, with ground glass opacity on CT; this is most consistent with an inflammatory process such as a drug reaction. | Small mild to moderately hypermetabolic right axillary lymph node is considered more likely benign although tumor cannot be entirely excluded. If there is a comparison baseline PET examination, this may be useful for further evaluation. Diagnostic CTs of the neck, chest, abdomen, and pelvis also performed at today's visit will be reported separately. |
Generate impression based on findings. | Pain in the low first metatarsal for one year. Check for stress fracture and pain on weight bearing in both knees. Breast cancer history Foot: Mild first MTP degenerative changes with worse scattered minimal changes distally. Soft tissues and alignment are unremarkable. No definite evidence of stress reaction, however a very mild periosteal reaction of the second metatarsal cannot entirely be excluded, given history, a minimal stress must otherwise be considered.Degenerative changes involving the talonavicular articulation, old and remote. Hindfoot otherwise unremarkableKnees: Mild bilateral scattered tricompartmental degenerative changes without evidence of additional distinct focal acute abnormality. No effusionsSpecifically no scanned structures demonstrate any suspicious lytic or sclerotic lesions to suggest metastatic disease | Mild scattered osteoarthritic changes involving both knees and feet with a questionable second metatarsal stress reaction |
Generate impression based on findings. | T2N2a HPV+ left tonsil squamous cell carcinoma treated with chemoradiotherapy and surgery. There are post-treatment findings with diffuse pharyngeal mucosal edema and interval left neck dissection with stranding along the left carotid sheath. There is no measurable mass in the left tonsillar fossa. There is no evidence of residual lymphadenopathy in the neck. There is superior portions of the left internal jugular vein is not apparent and may have been sacrificed. There is a right internal jugular venous catheter. There is mild atherosclerotic plaque at the bilateral carotid bifurcations. The airways are patent. There is reflux of air into the right parotid gland attributable to the puffed cheek technique. The salivary glands and thyroid are otherwise unchanged. There are is moderate mucosal thickening in the right maxillary sinus. There is multilevel degenerative spondylosis. The imaged intracranial structures are grossly unremarkable. The imaged portions of the lungs are clear. | Post-treatment findings without evidence of measurable residual tonsillar mass or lymphadenopathy in the neck. |
Generate impression based on findings. | Osteoarthritis and pain Diffuse demineralization limits sensitivityHands: Mild scattered osteoarthritic degenerative changes largely involving the radiocarpal joints and first and MCP articulations. Mild scattered degenerative changes are also observed in the distal articulations and most pronounced involving the right second PIP and DIP with mild angulation, presumably post dramatic and remote. No distinct superimposed inflammatory change, specifically no evidence to suggest erosions. Soft tissues unremarkableFeet: Mild degenerative changes largely involving the first MTP without discrete superimposed additional distal abnormality. Both mid feet demonstrate marked pes planus deformity with superimposed severe degenerative changes most pronounced involving the talonavicular and calcaneocuboid articulations, again bilaterally. Soft tissues are unremarkable.Knees: Severe osteoarthritic changes again observed a tricompartmental distribution with relative sparing of the lateral compartments bilaterally. Bone-on-bone narrowing, sclerosis and osteophytes are noted. Small knee effusions | Mild distal hands and feet osteoarthritis with more pronounced changes involving the mid foot bilaterally and severe disease involving both knees. See detail provided |
Generate impression based on findings. | Male 28 years old Reason: evaluate for kidney stone History: abdominal pain, vomiting, urinary retention ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No kidney is visualized in the right renal fossa. Left kidney is located normally in the left renal fossa without hydronephrosis. A malrotated midline pelvic kidney is noted with mild adjacent fat stranding. There is mild hydronephrosis and hydroureter of the pelvic kidney with a subcentimeter calculus present at the ureterovesical junction (series 3, image 124). RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Multiple phleboliths in the pelvis. | Malrotated right pelvic kidney with mild hydronephrosis and hydroureter with a subcentimeter obstructing calculus at the ureterovesical junction. |
Generate impression based on findings. | Palpitations. 24 hr uptake in preparation for ablation for Graves' disease. The 24 hour radioactive iodine uptake is 93% (normal range 10-30% at 24-hours). This has progressed significantly from the previous uptake value of 64%. | Markedly elevated thyroid uptake consistent with Graves' disease, with uptake significantly progressed from previous. |
Generate impression based on findings. | Left wrist pain Persistent volar distal radial side plate without evidence of hardware complication. Interval healing of the underlying comminuted fracture and distal ulnar fractures with associated deformity most pronounced involving the latter. Metacarpal joint again demonstrates mild degenerative changes with diffuse demineralization. Incompletely visualized deformity of the proximal first met at carpal, unchanged. | Interval healing with associated deformity of the distal radial and distal ulnar fractures. See detail provided |
Generate impression based on findings. | Reason: 4 years s/p induction therapy followed by minimally invasive esophagectomy for a post-treatment T3N0 adenocarcinoma. History: annual follow up CHEST:LUNGS AND PLEURA: Subpleural opacity in the right upper lobe compatible with scarring, unchanged.Multiple micronodules, some of which are calcified, compatible with previous infection.Elevation of left hemidiaphragm with adjacent compressive atelectasis, and generally unchanged.No suspicious nodules.MEDIASTINUM AND HILA: Nodular enlarged thyroid gland, unchanged.Right chest port with its tip in the SVC.No significant lymphadenopathy.Gastric interposition.Severe coronary artery calcification.No pericardial effusion.CHEST WALL: Degenerative disease in the spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypoplastic kidneys with small cysts.PANCREAS: Atrophic pancreas.RETROPERITONEUM, LYMPH NODES: Infrarenal IVC filter in place.Moderate aortic atherosclerosis.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No sign of locally recurrent or metastatic disease. |
Generate impression based on findings. | Pain and stiffness Feet: No radiographic abnormality. Specifically soft tissues are intact. Bilateral small os trigonum are observed, a congenital variant. Specifically no superimposed findings to support inflammatory changesHands: Juxta-articular osteoporosis without evidence of superimposed additional abnormalities. This nonspecific finding can be associated with inflammatory arthritis, however no specific changes are otherwise observed. Soft tissues and alignment preserved | Chest reticular osteoporosis without additional focal changes to support inflammatory arthritis involving both hands or feet. |
Generate impression based on findings. | Reason: ild, History: sob LUNGS AND PLEURA: Mild basilar reticular opacities, mild bronchial wall thickening, and mild basilar-predominant mosaic attenuation. No significant air-trapping seen on expiratory images.A single well-marginated noncalcified pleural-based nodule in the medial left lower lobe measures 20 x 15 mm (series 4, image 66).No focal air space consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is enlarged without pericardial effusion. The main pulmonary artery is significantly enlarged, suggestive of pulmonary hypertension. Mild coronary artery calcification. Status post mitral valve repair. Left chest pacer device with lead near the cardiac apex. No mediastinal or hilar lymphadenopathy.CHEST WALL: Mild degenerative disease of the thoracic spine. Status post median sternotomy.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Findings suggestive of pulmonary artery hypertension, with possibly associated mild basilar reticular opacities, bronchial wall thickening, and mild mosaic attenuation. 2. A 2-cm left lower lobe pleural-based nodule likely represents a solitary fibrous tumor of the pleura or other benign entity. PET imaging can be done to confirm benignity. |
Generate impression based on findings. | 17 year-old female with anterior mediastinal mass CHEST:LUNGS AND PLEURA: Moderate left pleural effusion and adjacent atelectasis.MEDIASTINUM AND HILA: Right chest wall port with central venous catheter tip extending to the cavoatrial junction. There is a large anterior mediastinal mass measuring up to 11 x 5 cm (image 32 series 3) causing compression of the left innominate vein. Extensive left supraclavicular lymphadenopathy measures up to 2.5 cm (image 77 series 8 0248).The heart size is normal without pericardial effusion.CHEST WALL: Right chest wall port. Left axillary lymphadenopathy measuring up to 1.9 cm (image 19, series 3). ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions or biliary ductal dilatation. The gallbladder appears normal.SPLEEN: No focal lesions.PANCREAS: Normal pancreatic enhancement.ADRENAL GLANDS: Normal bilateral adrenal glands.KIDNEYS, URETERS: Symmetric renal cortical enhancement.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: The bowel is normal caliber.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: 2.7 centimeter right adnexal cyst likely physiologic given the patient's age.BLADDER: Partially distended without abnormality.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Extensive anterior mediastinal, axillary, and supraclavicular lymphadenopathy with compression of the left innominate vein, likely representing lymphoma. |
Generate impression based on findings. | Arthrodesis Surgical fixation of T12 through L3 is observed with posterior pedicle screws and fixation bilaterally. Associated laminectomy and underlying degenerative changes most pronounced involving L1 through L3. Alignment grossly preserved. Surgical drain overlies soft tissues posteriorly | Posterior surgical fixation of T12 through L3 |
Generate impression based on findings. | History of squamous cell carcinoma of the larynx related with radiation in 1990 and more recently angiosarcoma of vocal cords treated via chemotherapy with clinical response. There are post-treatment findings in the laryngeal region without convincing evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The larynx appears grossly unremarkable. The thyroid and major salivary glands are unchanged. The major cervical vessels are patent. There is a right internal jugular venous catheter. There is multilevel degenerative spondylosis. The airways are patent. There are subcentimeter cystic nodules in the skin of the posterior lower neck, which may represent sebaceous cysts or similar entities. There is mild left maxillary sinus mucosal thickening. There are multiple periodontal lucencies and dental fillings. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | Post-treatment findings in the laryngeal region without convincing evidence of measurable tumor recurrence or significant lymphadenopathy in the neck. |
Generate impression based on findings. | Metastatic lung cancer on MPDL3280A. Compare with previous study and evaluate treatment response. LUNGS AND PLEURA: Mild emphysema. Scattered micronodules and scar like opacities, unchanged.Right lower lobe subpleural opacity (series 5, image 71), suggestive of post infectious scarring and organized pneumonia, unchanged.Right middle lobe nodule is 3 x 5 mm, unchanged (series 5, image 49).No new suspicious pulmonary nodules.MEDIASTINUM AND HILA: Reference left paratracheal lymph node is 5 mm in short axis (series 3, image 18), unchanged.Reference right paratracheal lymph node is 8 mm in short axis (series 3, image 24), unchanged.Reference retrocardiac soft tissue is 11 mm, previously 12 mm (series 3, image 60).Nonspecific soft tissue thickening in the right hilum is 9 x 35 mm, unchanged (series 3, image 51).Severe coronary artery calcification.CHEST WALL: Mild to moderate degenerative changes of the thoracolumbar spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Refer to separately dictated same-day CT abdomen/pelvis report. | No significant change in reference lesions. No new sites of disease. |
Generate impression based on findings. | Pain Overlying splint material obscures detail. Grossly symmetric mortise affixes a grossly aligned SER 4 injury. Specifically the distal fibular fracture is minimally displaced posteriorly. | Anatomic gross alignment of and SER 4 fractures |
Generate impression based on findings. | Female 61 years old Reason: pt w suspected tertiary hyoperparathyroidism, please assess parathyroid glands History: hyperparathyroidism RIGHT LOBE MEASUREMENTS: 6.7 x 2.9 x 3.7 cm.LEFT LOBE MEASUREMENTS: 6.5 x 2.6 x 2.6 cmISTHMUS MEASUREMENTS: .8 cm in thicknessRIGHT LOBE: Large lower lobe nodule measuring 4.8 x 3.3 x 3.9 cm. few scattered highly reflective echoes likely calcifications. Portions of the lesion have a hypoechoic capsule. Hypervascular on color Doppler imaging.LEFT LOBE: Heterogeneous with ill-defined nodules and areas of calcification.In or abutting the dorsal aspect of the upper pole is a complex nodule at solid and cystic components measuring 1.9 x 1.4 x 1.8 cm. It could represent an exophytic thyroid nodule or lymph node. This appearance would be atypical for parathyroid nodule.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: Possible extra thyroidal nodule as described above which I favor to be an exophytic thyroid nodule or lymph node.LYMPH NODES: No significant abnormality noted.OTHER: Dense calcification is seen in the left common carotid artery. | Dominant nodule or conglomerate nodules in the right lobe as described.Heterogeneous right lobe with ill-defined nodules and calcifications.Complex nodule may represent exophytic left upper pole nodule or lymph node.None of these lesions are typical for parathyroid adenoma.Common carotid artery calcification. |
Generate impression based on findings. | Check for fracture. Knee replacement Bilateral total knee arthroplasties are observed without evidence of immediate postprocedural complication. Multiple small punctate calcifications are seen throughout the joint, the largest observed superior to the patella, and all possibly loose bodies within the joint. Atherosclerotic disease | Bilateral total knee arthroplasties, see detail provided |
Generate impression based on findings. | Female 68 years old Reason: NGT History: NGT Nasogastric tube is projected over the course of the distal trachea and right main bronchus. The tip is projected above the medial right hemi diaphragm. The possibility of bronchial intubation should be considered. Nonobstructive bowel gas pattern. The pelvis is incompletely imaged. | Nasogastric tube tip is projected above the right hemidiaphragm. The possibility of bronchial intubation should be considered. Discussed with Dr. Buerki by myself Dr. Ward 02/13/15 |
Generate impression based on findings. | 12-year-old male status post right foot injury, tender to the distal metatarsal and proximal phalanxVIEWS: Right foot AP, oblique and lateral (3 views) 2/13/15 13:32 Alignment is anatomic. No fracture or other osseous abnormality is noted. | Normal examination. |
Generate impression based on findings. | Hyperparathyroidism. Assess for parathyroid adenomas. On early images, a small but suspicious abnormal focus of radiotracer uptake is seen posterior to upper pole of the left thyroid lobe.Additionally, both the left and right lower parathyroid glands appear minimally prominent; a superimposed hyperplasia cannot be excluded, though, this may just represent improved spatial resolution of normal glands due to the patient's small size. Incidental note of benign brown fat metabolism of the bilateral supraclavicular regions. The right thyroid lobe appears to measure 3.0 cm and the left lobe 3.5 cm in length. | 1. Findings highly suspicious for a parathyroid adenoma posterior to the left upper thyroid pole.2. Superimposed hyperplasia of both lower parathyroid glands cannot be excluded but could also represent artifact related to the patient's small size. |
Generate impression based on findings. | Dyspnea and right upper lobe nodule. Evaluate for mediastinal and extrathoracic LAD. RADIOPHARMACEUTICAL: 12.3 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 83 mg/dL. Today's CT portion grossly demonstrates the spiculated right upper lobe nodule seen on the recent previous chest CT, which measures 2 cm and is not significantly changed. Extensive emphysematous change is again visualized. The prior small pleural effusions have resolved. Focal thickening of the proximal medial gastric wall is noted. Today's PET examination demonstrates mildly abnormally elevated activity of the spiculated right upper lobe nodule with an SUVmax of 1.7. Mild symmetric bilateral hilar activity which is typically seen with granulomatous inflammation. Tumor activity would be considered less likely. Focal increased curvilinear activity in the soft tissues adjacent to the right hip is likely reactive in etiology. A medium sized focus of activity is noted in the proximal stomach just distal to the GE junction with an SUVmax of 4.4. While diffuse gastric activity is typically benign, this is much more focal than typically seen which raises the question of a possible gastric neoplasm. Alternatively gastritis could conceivably have this appearance. Otherwise no suspicious FDG avid activity is noted elsewhere. | 1.Spiculated right upper lobe lung mass which is FDG avid and very suspicious for lung cancer, possibly of a lower grade given the lower level of uptake. 2.No convincing FDG avid metastatic disease. The mild symmetric bilateral hilar activity more likely represents granulomatous inflammation3.Proximal gastric mass-like uptake is of some suspicion but equivocal for a synchronous gastric neoplasm. Further information may be obtained with an upper endoscopy if clinically warranted. |
Generate impression based on findings. | Male 46 years old Reason: s/p ORIF History: Shoulder pain Four views of the left shoulder show a side plate with multiple screws device affixing a comminuted fracture of the proximal humerus in near-anatomic alignment. Again seen is associated callus formation, which has progressed when compared to the prior exam, compatible with progression of interval healing. Interval removal of the surgical drain and overlying skin surgical staples. | Orthopedic fixation of healing proximal humerus fracture as described above. |
Generate impression based on findings. | pT4aN0 left retromolar trigone squamous cell carcinoma treated via radiation therapy. There are unchanged post-treatment findings in the neck, including total thyroidectomy, lymph node dissection, left palate flap reconstruction, and partial left mandibulectomy with bone graft and plate reconstruction. There is no definite evidence of measurable mass lesions in the neck. Likewise, there is no evidence of significant cervical lymphadenopathy. There is denervation atrophy of the left vocal cord. The salivary glands are unchanged. There is mild plaque at the carotid bifurcations. There is a dysmorphic left mesiodens. There is scattered mild paranasal sinus opacification. There is partial opacification of the left mastoid air cells. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are essentially clear. | Stable post-treatment findings without definite evidence of tumor recurrence at the treatment sites or significant lymphadenopathy in the neck. |
Generate impression based on findings. | There is streak artifact from dental amalgam limiting evaluation. There are postoperative and posttreatment findings in the neck with no discrete recurrent tongue mass. There is hyperenhancement and edema of the oropharyngeal mucosa compatible with posttreatment mucositis. There is also new thickening and hyperenhancement of the aryepiglottic folds, worse on the left, likely representing posttreatment mucositis and edema. Likewise, there is diffuse stranding of the subcutaneous tissues in the anterior neck, which may represent radiation dermatitis. There is slight interval enlargement of the hyperenhancing bilateral level Ib lymph nodes measuring 9 mm each, previously measuring up to 7 mm each. However, there is no evidence of significant lymphadenopathy in the neck based on size criteria. The thyroid is unremarkable. The major cervical vessels are patent. There is no discrete osseous lesion. There are mild degenerative changes in cervical spine with mild spinal canal and neural foramen narrowing at C5-6 and C6-7. The airways are patent. The imaged intracranial structures are unremarkable. There is minimal left maxillary sinus mucosal thickening. There is a new right chest wall Mediport catheter. | Post-treatment findings in the neck with slight interval enlargement of hyperenhancing bilateral level Ib lymph nodes, which are likely reactive, and no evidence of recurrent measurable tumor in the neck otherwise, although assessment of the oral cavity region is limited due to dental artifacts. |
Generate impression based on findings. | 14 year old female with knee pain for weeks with small swelling in the popliteal fossa. Question lymph node seen on ultrasound also with MCL and joint line pain. Evaluate for medial meniscal tear and for mass in popliteal fossa. MENISCI: Normal appearance.ARTICULAR CARTILAGE AND BONE: Normal with no evidence of fracture or dislocation.LIGAMENTS: Normal. EXTENSOR MECHANISM: Normal.ADDITIONAL | Minimal joint effusion with no other abnormality noted. |
Generate impression based on findings. | Reason: mets lung cancer. s/p chemo. Pls c/w previous study and evaluate tx response. History: lung cancer CHEST:LUNGS AND PLEURA: Patchy lower zone air space and groundglass opacities, slightly increased compared to CT scan of 10/2/2014 and similar to a PET CT scan 11/14/2014 allowing for differences in technique. Given the diagnosis of mucinous adenocarcinoma, these findings are compatible with metastatic tumor but not specific.MEDIASTINUM AND HILA: No significant lymphadenopathy.Catheter extending to the SVC.No visible coronary artery calcification.No pericardial effusion.CHEST WALL: Elevation of the right hemidiaphragm.Degenerative disease in the spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Slight increase in lower zone pulmonary nonsolid nodules, suspicious for mucinous adenocarcinoma. |
Generate impression based on findings. | Ms. Magee-Jones is a 44 year old female with a personal history of left breast mastectomy for IDC/DCIS in December 2013. Patient has no current breast related 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. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Female 46 years old Reason: ankle pain History: pain. There is evidence of a remote prior injury along the medial ankle with a well-defined and corticated ossicle fragment in the medial ankle joint space. There is no acute fracture or dislocation. There is mild osteoarthritis of the ankle and midfoot. | No acute fracture or dislocation. Mild osteoarthritis as described above. |
Generate impression based on findings. | Reason: recurrent urothelial cancer, evaluate for measurable disease History: recurrent urothelial cancer, evaluate for measurable disease LUNGS AND PLEURA: Stable bilateral apical pleural scarring.New scattered right upper and lower lobe small pulmonary nodules measuring up to 6 mm (series 5, image 86). Additional scattered small right lung nodules are stable to decreased in prominence.A reference nodule adjacent to the minor fissure measures 3 mm (series 4, image 54), mildly decreased in density.A reference nodule adjacent to the right hilum measures 6 x 3 mm (series 4, image 44), decreased in size and density.Calcification of the left pleura (series 4, image 82).No new focal air space consolidations. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. Severe coronary artery calcification. Status post CABG. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Small perihepatic and perisplenic ascites. Severe atherosclerotic calcification of the abdominal aorta and its branches. | Multiple small pulmonary nodules, some new from the prior exam, some decreased in prominence. Continued close interval follow up is recommended in a high-risk patient. |
Generate impression based on findings. | Female 9 years old Reason: r/o constipation History: constipation, nauseaVIEW: Abdomen AP (one view) 2/13/15 at 1420 hrs. Interval decreasing in the amount of fecal accumulation. Normal abdominal gas pattern. No obstruction or free air. | Improvement in fecal burden as described. |
Generate impression based on findings. | Female 81 years old with metastatic lung cancer on MPDL3280A. Evaluate for treatment response. ABDOMEN:LUNG BASES: Stable bibasilar emphysematous changes. Please refer to concomitant CT of the chest for additional lung findings.LIVER, BILIARY TRACT: Stable segment 7 right lobe subcentimeter low attenuation focus. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Findings obscured by beam hardening artifact from right hip arthroplasty.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of the lumbar spine with leftward curvature. Right hip arthroplasty.OTHER: No significant abnormality noted | Stable negative examination without evidence of inflammatory or metastatic process. |
Generate impression based on findings. | 1-year-old male with neuroblastoma, assess disease status CHEST:LUNGS AND PLEURA: Small left pleural effusion. No suspicious nodules or masses.MEDIASTINUM AND HILA: Heterogeneously enhancing right paraspinal mass measures 2.1 x 2.7 cm (image 26, series 3.) Heterogeneous left para-aortic mass extends inferiorly into the abdomen. The heart size is normal.CHEST WALL: Right chest wall port with catheter extending to the right atrium.ABDOMEN:LIVER, BILIARY TRACT: The gallbladder is moderately distended and otherwise, normal. Within the right hepatic lobe there are streaky hypodensities which are nonspecific, but may represent disease involvement.SPLEEN: No significant abnormality noted.PANCREAS: Displaced anteriorly by extensive retroperitoneal disease involvement.ADRENAL GLANDS: Large, partially calcified mass replaces the left adrenal gland and displaces the left kidney inferiorly.KIDNEYS, URETERS: Symmetric renal cortical enhancement without hydronephrosis. The left kidney is displaced inferiorly by tumor.RETROPERITONEUM, LYMPH NODES: Extensive conglomerate retroperitoneal masses extend from the diaphragmatic hiatus inferiorly to the level of the left common iliac artery. Mass extends across the midline to the level of the right renal pelvis and displaces the right renal vein and IVC anteriorly. The aorta, celiac artery, SMA, and IMA are encased by tumor with displacement of the branching visceral vasculature.For reference, a conglomerate left para-aortic mass at the level of the SMA origin measures 6.9 x 3.2 cm (image 58, series 3).BOWEL, MESENTERY: The small bowel is normal in caliber.BONES, SOFT TISSUES: No osseous lesions are identified.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Moderately distended.LYMPH NODES: Conglomerate retroperitoneal mass extends inferiorly from the abdomen to the level of the left common iliac artery.BOWEL, MESENTERY: The bowel is normal in caliber.BONES, SOFT TISSUES: No osseous lesions are identified.OTHER: No significant abnormality noted | Extensive disease involvement of the chest, abdomen, and pelvis, with reference measurements described above. |
Generate impression based on findings. | Ms. Porter is a 47 year old female with a personal history of right breast mastectomy in 2009 for cancer followed by chemoradiation and hormonal therapy. She also had left breast reconstruction. Family history of breast cancer in sister, diagnosed at the age of 36. Cowden syndrome. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Postsurgical architectural distortion is identified in the left breast, compatible with prior breast reduction surgery. Scattered benign punctate calcifications and inferior left breast skin thickening (presumably from keloids) are stable in the left breast. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the left breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left 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. | 11-week-old male with undescended testes, multiple congenital anomalies. Evaluate location of testicles. RIGHT TESTIS: Located in the right inguinal canal measuring 0.8-cm x 0.8 cm x 0.5 cm. LEFT TESTIS: Located in the left inguinal canal measuring 1.1-cm x 0.8 cm x 0.5 cm. RIGHT EPIDIDYMIS: Located in the right inguinal canal measuring 0.4-cm x 0.3 cm x 0.5 cm. LEFT EPIDIDYMIS: Located in the left inguinal canal measuring 0.4 cm x 0.3 cm x 0.3 cm.OTHER: Patent left peritoneovaginal tract with small amount fluid in the left scrotal sac. | Bilateral testes and epididymi are located in their respective inguinal canals. Patent left peritoneovaginal tract with small amount of fluid in the left scrotal sac. |
Generate impression based on findings. | 75-year-old female. Follow-up of small pulmonary nodules. History of breast cancer and bladder cancer. LUNGS AND PLEURA: Unchanged scattered micronodules, most likely post-inflammatory. The reference right lower lobe nodule unchanged (series 5, image 39); its angular morphology and location adjacent to the fissure is consistent with a benign intrapulmonary lymph node.Very mild lower lobe bronchiectasis and basilar scarring.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Severe coronary artery calcification and thoracic aorta calcification.Normal heart size without pericardial effusion.CHEST WALL: Post surgical changes of left lumpectomy with surgical clips. Left breast soft tissue nodule, unchanged.No axillary lymphadenopathy. Mild degenerative changes of the thoracolumber spine.UPPER ABDOMEN: Refer to same day separately dictated CT abdomen/pelvis report. | No evidence of metastatic disease in the chest. |
Generate impression based on findings. | 33-year-old male with pain in the left hip for several weeks that is worse with walking. There is no acute fracture or dislocation. There are mild-to-moderate arthritic degenerative changes affecting the acetabular joint. | No acute fracture or dislocation. Mild to moderate osteoarthritis as described above |
Generate impression based on findings. | Male 63 years old Reason: core biopsy of abdominal mass for pathology confirmation and DNA analysis History: 63 yo M with history of resected renal carcinoma and resected prostate cancer, with new abdominal lesions Written informed consent was obtained explaining the risks of pain, infection, bleeding, colonic perforation and tumor spread.Patient was prepped and draped in sterile fashion. Skin was anesthetized with 1% lidocaine.Lesion in the peritoneal catheter only just deep to the right rectus muscle near the descending colon was targeted corresponding to 1/26/15 series 7 image 80/182. Coaxial technique was used with an 18-gauge achieve core biopsy needle.A total of 3 core biopsy samples were obtained and placed in a formalin. Samples were hand delivered to anatomic pathology.Following the procedure the patient had transient abdominal pain followed by hypotension and bradycardia. After discussion with Dr. Shalav of the patient was evaluated by urology resident on call. Patient received IV fluids. Symptoms completely resolved. Patient was discharged home of the reported instructions. Blood loss 5 cc. | Successful targeting peritoneal implant an 18-gauge core biopsies. Complications of transient abdominal pain and hypotension resolved. |
Generate impression based on findings. | History of HNC. Metastatic disease. Chronic cough. CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary nodules consistent with metastases, significantly increased in number and size from prior.Left upper lobe nodule is 9 mm (series 5, image 24) and a right upper lobe nodule is 6 mm (series 5, image 26).Extensive pleural metastases with a large left malignant pleural effusion, new from prior. Trace right pleural effusion.Tumor obstruction of the bronchi of the lateral segment of the right middle lobe and lingula with postobstructive atelectasis/pneumonitis.MEDIASTINUM AND HILA: Confluent bilateral hilar lymphadenopathy, reference left hilar lymph node is 34 mm in short axis (series 3, image 44), previously 24 mm.Normal heart size. Small pericardial effusion, likely malignant.No visible coronary artery calcification.CHEST WALL: Lytic metastasis of the left posterior T6 rib with large soft tissue component measuring 60 x 31 mm (series 3, image 36) with invasion into the posterior chest wall musculature, previously 30 x 17 mm. Left T12 rib metastasis, new from prior. Likely also a small lytic metastasis in the superior right L2 vertebral body.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Numerous hepatic metastases, increased in size and number from prior exam. For reference, a left hepatic lobe lesion is 48 x 46 mm, previously 26 x 25 mm.SPLEEN: Nonspecific splenic hypodensity, unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left renal cyst with rim calcifications, unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Significant interval progression of metastatic disease with lung/pleural, liver, and bone metastases. |
Generate impression based on findings. | Female 55 years old Reason: wrist pain, distal radius fracture History: wrist pain, distal radius fracture. There is diffuse demineralization of bones. An ulnar minus is noted. Again seen is a nondisplaced markedly occult and extra-articular transverse fracture of the distal radius in anatomic alignment. The fracture line appears unchanged from the prior exam. No additional acute fractures are identified. | Distal radius fracture as described above. |
Generate impression based on findings. | Male 61 years old. Reason: melanoma please eval for recurrence of disease History: melanoma CHEST:LUNGS AND PLEURA: Stable pleural thickening and calcification.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Status post thyroidectomy.ABDOMEN:LIVER, BILIARY TRACT: Hypoattenuating segment 7 lesion is stable and measures 1.1 x 0.9 cm, previously 1.0 x 1.0 cm (series 3, image 96). Subcentimeter segment 4 lesion is stable and likely represents a hepatic cyst. Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Scattered colonic diverticulosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Bladder diverticula again noted.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable examination without evidence of disease recurrence. |
Generate impression based on findings. | Chronic subdural hematoma, status post evacuation There is a left-sided subdural collection measuring up to 11 mm in thickness along the left frontotemporoparietal convexity. There is a hematocrit effect. There is slight enlargement compared to immediate postoperative study from 1/19/2015 but is smaller compared to 1/18/2015.There is mild local mass effect on the left cerebral convexity and 3-mm rightward midline shift. No downward herniation. No hydrocephalus. Scattered areas of hypoattenuation in the periventricular and subcortical white matter are nonspecific but compatible with chronic small vessel ischemic changes. Left-sided burr holes again seen. | Left-sided subdural collection has enlarged compared to immediate postoperative study from 1/19/2015 but is smaller compared to 1/18/2015. There is mild mass effect with minimal rightward midline shift. |
Generate impression based on findings. | History of brain lesion, evaluate for primary lesion. Exam somewhat limited by motion artifact.CHEST:LUNGS AND PLEURA: Moderate-severe emphysema. Apical and left basilar atelectasis/scarring. No suspicious pulmonary masses.MEDIASTINUM AND HILA: Right-sided central venous catheter with tip at the atrial caval junction. Mild cardiomegaly. Moderate atherosclerotic calcifications of the coronary arteries. Moderate hiatal hernia. No hilar or mediastinal adenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic kidneys. Small punctate renal hilar calcifications may be vascular or nonobstructing calyceal calculi. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcifications of the abdominal aorta and its braches. BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction.BONES, SOFT TISSUES: Moderate degenerative changes of the visualized thoracolumber spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Leiomyomatous uterus. BLADDER: Foley catheter in partially collapsed bladder. LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate degenerative changes of the visualized thoracolumber spine.OTHER: No significant abnormality noted. | 1.No specific evidence of primary malignancy.2.Moderate-severe emphysema.3.Atrophic kidneys. |
Generate impression based on findings. | Ms. Kim is a 51 year old female with a known history of bilateral benign breast calcifications. No current breast related complaints. No family history of breast cancer. 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. Bilateral benign punctate calcifications are stable, particularly in the right upper outer breast. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | Bilateral benign breast calcifications. 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. | Salivary gland carcinoma with metstases. Neck: There is a heterogeneous mass arising from the right submandibular gland that measures up to approximately 45 mm, previously 40 mm. There is erosion of the adjacent lingual surface of the right mandibular body and expansion of a portion of the inferior alveolar canal. There is a new lytic lesion in the C6 vertebral body, without loss of height. There is no significant interval change in size of a necrotic right level 2 lymph node that measures 17 mm in short axis. However, right parotid lymph nodes have increased in size. The thyroid appears unremarkable. The major cervical vessels are patent. The airways are patent. The imaged intracranial structures are unremarkable. There are multiple nodules in the partially-imaged lungs. There is a partially-imaged large left pleural effusion.Head: There is no evidence of intracranial mass or abnormal enhancement. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | 1. Interval increase in size of the right submandibular carcinoma with erosion into the right mandible and suggestion of perineural spread into the inferior alveolar nerve. 2. No significant interval change in size of a necrotic right level 2 lymph node. However, right parotid lymph nodes have increased in size and may also be involved by metastatic disease.3. Partially-imaged multiple lung metastases and large left pleural effusion.4. A new lytic lesion in the C6 vertebral body likely represents a metastasis.5. No evidence of intracranial metastases. |
Generate impression based on findings. | Female 53 years old pain joint and forearm. There is demineralization of the bones. Mild degenerative changes affect the carpal bones and proximal ulnar and radial bones. There is an increased scapholunate interval. An ulnar minus is noted. | Mild degenerative changes as described above. |
Generate impression based on findings. | 75 year old female with history of bladder cancer. 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: Please see dedicated chest CT from same day for full details regarding the chest.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Unchanged punctate granulomata.PANCREAS: Mild fatty atrophy. No pancreatic ductal dilatation.ADRENAL GLANDS: Small left adrenal nodule is unchanged and likely benign.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Severe calcific arteriosclerotic disease affects the aorta.BOWEL, MESENTERY: Normal caliber small bowel without evidence of obstruction. Colonic diverticulosis without diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: The uterus is absent.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis without diverticulitis.BONES, SOFT TISSUES: Degenerative changes affect the lower lumbar spine with grade 1 anterolisthesis of L4 on L5 with degenerative disk disease affecting L4-L5 and L5-S1 with vacuum disk phenomenon. Sclerotic left ileal lesion stable since 2009 and likely benign.OTHER: No significant abnormality noted | 1.No specific evidence of metastatic disease.2.Colonic diverticulosis without diverticulitis. 3.Please see dedicated chest CT from same day for full details regarding the chest. |
Generate impression based on findings. | Ms. Abdelhamid is a 56 year old female with a personal history of benign left breast biopsy in 2007. Family history of breast cancer in mother (diagnosed at the age of 66) and 3 maternal aunts (one of which was diagnosed at the age of 40). No current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Previously characterized cyst in the right lower outer breast has decreased in size when compared to prior exams. 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. | Involuting cyst in the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | ConstipationVIEW: Abdomen AP (one view) 2/13/15 at 1452 hrs NG tube tip is in the stomach. Normal abdominal gas pattern. No evidence of obstruction or free air. | Normal examination. |
Generate impression based on findings. | Male 7 years old Reason: degree of fecal impaction History: constipationVIEW: Abdomen AP (one view) 2/13/15 at 1516 hrs. Mild fecal accumulation with no evidence of obstruction or free air. | Mild fecal accumulation. No obstruction. |
Generate impression based on findings. | Female 53 years old Reason: worsening lft wrist pain and swelling ; low back pain History: wrist pain, low back pain. There is loss of lordosis and straightening of the lumber spine which is of uncertain significance. There are minimal anterior vertebral body osteophytes. vertebral body heights and intravertebral disk spaces are preserved. Alignment is preserved. Surgical clips compatible with partial hysterectomy are identified in the pelvis. | No acute fracture or malalignment. Minimal degenerative changes as described above. |
Generate impression based on findings. | Headaches and neck pain, bullet wound in face with bullet lodged in back of head. Neck pain. Head:Large bullet fragment lodged within basisphenoid/sella, additional metallic fragments within the ethmoid and sphenoid sinuses, and irregularity involving the left partially visualized left nasal bone are compatible with prior trauma. Streak artifact associated with above slightly limits evaluation. No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. No extra-axial collections. Ventricles are within normal limits without evidence of hydrocephalus. Small scattered areas of hypoattenuation are seen in the periventricular and subcortical white matter which are nonspecific but compatible with mild chronic small vessel ischemic changes.There is mild opacification of the ethmoid sinus cavity which may be related to the adjacent metallic fragments. Visualized paranasal sinuses and mastoid air cells are otherwise clear.Cervical spine:Vertebral body heights in the cervical spine are normal. There is reversal of normal cervical lordosis. Alignment is otherwise maintained. There are degenerative changes at multiple levels, particularly at C4-C5 and C5-C6 with disk space narrowing, vacuum disk phenomenon, and associated endplate changes. Individual levels as below: C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal or neural foramina.C4-5: Disk osteophyte complex and bilateral uncovertebral hypertrophy result in moderate right and mild left neural foraminal stenosis. There is mild spinal canal narrowing. C5-6: Disk osteophyte complex and bilateral uncovertebral hypertrophy result in moderate to severe left neural foraminal stenosis. No significant right neural foraminal narrowing. There is mild spinal canal narrowing.C6-7: No significant compromise to the spinal canal or right neural foramina. There is minimal left neural foraminal narrowing laterally. There is left-sided facet arthropathy.C7-T1: No significant compromise to the spinal canal or neural foramina.Paraspinous soft tissues are unremarkable. | 1. No intracranial mass or mass-effect.2. Large bullet fragment lodged in the basisphenoid bone with additional fragments in the left ethmoid sinuses. 3. Degenerative changes in the cervical spine at C4-C5 and C5-C6 with moderate right C4-C5 and moderate to severe left C5-C6 neural foraminal stenosis. There is also mild spinal canal narrowing at this level. |
Generate impression based on findings. | Age: 68 years. Sex : Male. Reason for study: Reason: dysphagia, encephalopathy History: as above. Fluoroscopic guidance was provided for an oropharyngeal motility study performed by the Speech Pathology section of the ENT service. The examination was recorded on videotape. No static or hard copy films were obtained. The exam was positive for penetration and positive for aspiration. FLUOROSCOPY TIME: One minute and 10 seconds. | The examination was positive for penetration and positive for aspiration. Please see speech pathology report for additional findings and feeding recommendations. |
Generate impression based on findings. | 49 years, Female. Reason: OG placement History: OG placement NG tube tip projects over the gastric body. Nonobstructive bowel gas pattern. A vascular catheter projects over the right hemipelvis. | NG tube projects over the gastric body. |
Generate impression based on findings. | Age: 57 years. Sex : Male. Reason for study: Reason: 57 yo M with newly dx advanced stage R Lung adenocarcinoma found to have R vocal cord paresis - eval aspiration risk History: Paretic R vocal cord, no clinical signs of aspiration. Fluoroscopic guidance was provided for an oropharyngeal motility study performed by the Speech Pathology section of the ENT service. The examination was recorded on videotape. No static or hard copy films were obtained. The exam was positive for penetration and negative for aspiration. FLUOROSCOPY TIME: Two minutes and 44 seconds. | The examination was positive for penetration and negative for aspiration. Please see speech pathology report for additional findings and the recommendations. |
Generate impression based on findings. | NSCLC initial staging. CHEST:LUNGS AND PLEURA: Right lower lobe infrahilar solid mass measures 50 x 64 mm (series 3, image 42), consistent with a primary lung malignancy.Ill-defined mixed solid and groundglass mass in the right upper lobe is 47 x 54 mm (series 4, image 32), suspicious for a synchronous primary lung malignancy, specifically mucinous adenocarcinoma.Multiple bilateral solid and groundglass nodules consistent with metastases from these respective two primaries. For reference, a right upper lobe solid nodule is 15 mm (series 4 image 41) and a left upper lobe solid nodule is 7 mm (series 4, image 39).MEDIASTINUM AND HILA: Right hilar and mediastinal lymphadenopathy. For reference, a left paratracheal lymph node is 17 mm in short axis (series 3, image 17).Normal heart size without pericardial effusion.Severe coronary artery calcification.CHEST WALL: Mild degenerative changes of the thoracolumbar spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Left hepatic lobe mass is 22 x 19 mm (series 3, image 87), highly suspicious for a metastasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Calcified atherosclerotic disease of the abdominal aorta.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Mild degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted. | 1. Right lower lobe infrahilar mass consistent with primary lung malignancy.2. Mixed solid and groundglass right upper lobe mass is suspicious for a synchronous primary lung malignancy, specifically a mucinous adenocarcinoma.3. Mediastinal/right hilar lymph node metastasis and bilateral lung metastases.4. Solitary liver metastasis. |
Generate impression based on findings. | Female 68 years old Reason: NGT push in History: NGT reposition Lung bases clear. Enteric tube with tip projected over the distal gastric body. Nonobstructive bowel gas pattern. Degenerative changes of the lumbar spine. Amorphous calcifications projected over the pelvis, likely within a fibroid uterus. | Enteric tube with tip projected over the distal gastric body. Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Female 39 years old Reason: H/O Hodgkin lymphoma, nodular sclerosis s/p 4 cycles of ABVD chemotherapy. Please compare History: Hodgkin lymphoma, nodular sclerosis CHEST:LUNGS AND PLEURA: Bilateral patchy groundglass opacities in both lungs, nonspecific and may represent edema versus drug reaction versus atypical infection.MEDIASTINUM AND HILA: Bulky predominantly anterior mediastinal adenopathy is significantly decreased in size compared to previous study. Right sided anterior mediastinal adenopathy now measures 6.6 x 3.6 cm on image number 45, series number 1301. This adenopathy was measuring 8.8 x 4.8 cm on image number 46, series number 13 on chest CT dated 8/16/2014.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral nephrolithiasis. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Significant interval decrease in the retroperitoneal adenopathy. An index left para-aortic lymph node was previously measuring 4.1 x 2.7 cm on image number 84, series number 3. This lymph node now is measuring 2.2 x 1 cm on image number 107, series number 1301.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: 4.2 by 3.1-cm right ovarian cyst, new from previous study.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. | Significant interval decrease in the size of the mediastinal and retroperitoneal adenopathy. New right ovarian cyst. |
Generate impression based on findings. | 7-week-old male status-post mandibular distraction, pins removed 2/6 now with swollen, firm left cheek/jaw line. Evaluate for jawline abscess or drainable fluid collection. In the region of the left cheek/jaw line surgical bed there is an irregular predominantly hypoechoic collection measuring 2.3 cm x 1.7 cm x 2.9 cm with minimal peripheral flow on color doppler images. No loculated fluid collection or abscess is seen. | Postsurgical changes in the left cheek/jaw line surgical bed. No loculated fluid collection or abscess is seen. |
Generate impression based on findings. | 47 years, Male. Reason: Dobbhoff placement History: Dobbhoff placement LVAD, sternotomy wires, plates, mitral valve prosthesis, Swan-Ganz catheter, central venous catheter tip, surgical staples noted. Dobbhoff tube tip projects over the gastric body. Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. Retrocardiac opacity persists. | Dobbhoff tube tip projects over the gastric body. |
Generate impression based on findings. | Female 67 years old Reason: 67 y/o female met colon ca. with reports of swelling and pain to R shoulder/upper back. On chemotherapy. History: see above Right internal jugular vein is thrombosed. No evidence of abscess or collection along the port. | Thrombosis of the right internal jugular vein.Carrie Eickhoff (APN) was notified and acknowledged about these findings at the time of the dictation. Patient was instructed to go to 6E, IV therapy. |
Generate impression based on findings. | Reason: evaluate bleeding and/or aneurysm History: brb per nose/mouth Neck CTA: The patient is status post bilateral common carotid stent placement and proximal embolic coil occlusion of the left superior thyroidal artery an embolic coil occlusion along branches of the left inferior thyroidal artery. There is no evidence for pseudoaneurysm along the tumor bed. The patient is now status post recent left internal card artery stent placement.The patient is status post tracheostomy, laryngectomy, voice prosthesis, partial thyroidectomy and right neck dissection. There is irregularity of the neopharynx, but no definite evidence of discrete mass lesions or significant cervical lymphadenopathy. The salivary glands and residual left thyroid lobe are unchanged. There is an irregular airfilled sinus tract between the voice prosthesis and the esophagus. This was present on the prior exam as well.There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.Nasopharyngeal airway and oropharyngeal airway are opacified and appearThe neck is in a flexed position.There is interstitial thickening at the lung apices likely related to scar formation.Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are intact.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a posterior fossa subdural effusion present which likely represents atrophy. It is stable compared to the prior CT from 11/2/14.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate scattered opacities. The visualized portions of the mastoid air cells are opacified partially. The visualized portions of the orbits are intact. | 1.No evidence for pseudoaneurysm to explain the patient's nasopharyngeal bleeding.2.The vessels nearest to the bleeding site are the left inferior thyroidal branches supplying the remaining thyroid gland and the tissues at the left peristomal area.3.No evidence for cervicocerebral occlusive disease.4.The patient is status post neck surgery as detailed above. |
Generate impression based on findings. | 16-year-old male with fall, swelling/pain in left ankle.VIEWS: Left ankle AP, lateral, oblique (3 views) 2/13/2015 13:59 No evidence of fracture or dislocation. No soft tissue swelling. Normal alignment. | Normal examination. |
Generate impression based on findings. | Stage 3 melanoma of oral mucosal origin, status post resection of recurrence. Hardware in the left mandible produces considerable streak artifact, which obscures surrounding structures. There are findings related to bilateral neck dissection and left parotidectomy. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy. The thyroid is not identified and there is unchanged nonspecific ill-defined soft tissue in the right thyroidectomy bed, without evidence of discrete tumor. There is reflux of air into the parotid ducts related to puff-cheek technique. The major cervical vessels are patent. There is unchanged multilevel degenerative spondylosis. The airways are patent. The imaged intracranial structures are unremarkable. There is mild scattered mucosal thickening in the paranasal sinuses. The imaged portions of the lungs are clear. | No evidence of measurable mass or significant lymphadenopathy in the neck. |
Generate impression based on findings. | Reason: Stem cell transplant patient with fevers and new left basilar opacity seen on xray History: fevers, cough LUNGS AND PLEURA: Scattered patchy groundglass opacities and bronchial wall thickening throughout the lungs are mildly increased from the prior exam. Left greater than right basilar consolidation has increased from the prior exam, with air bronchograms, suggestive of aspiration/infection. No new suspicious pulmonary nodules or masses. No pleural effusions.MEDIASTINUM AND HILA: The heart is mildly enlarged with minimal pleural fluid/thickening, stable. Moderate coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: Unchanged moderate bilateral axillary lymphadenopathy, which was not seen on the prior exam dated 07/2014. Mild degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Scattered groundglass opacities and bronchial wall thickening, along with new/increased basilar consolidation, may represent pneumonia, including viral pneumonia. Findings also raise the question of graft-versus-host disease.2. Bilateral axillary lymphadenopathy is new from 07/2014, raising the question of treatment-related lymphoma. |
Generate impression based on findings. | Male 80 years old Reason: HCC staging History: abd pain. Biopsy proven hepatocellular carcinoma. ABDOMEN:LUNG BASES: Left basilar atelectasis. No suspicious masses or nodules. No pleural effusions.LIVER, BILIARY TRACT: Encapsulated heterogeneous mass in the right hepatic lobe with patchy areas of enhancement. The mass has slightly increased in size now measuring 15.0 x 10.6 cm (series 4, image 53), previously 13.4 x 9.3 cm. In the current study, there is decreased enhancement of the lesion. The lesion abuts the gallbladder, colon, and duodenum and displaces the duodenum and pancreas leftward. The lesion compresses the IVC.Two subcentimeter hypoattenuating foci in the liver are stable and too small to characterize.SPLEEN: Normal splenic size.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the thoracic spine.OTHER: 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 | Large right hepatic hepatocellular carcinoma with slight interval increase in size and decreased enhancement. |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.