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Generate impression based on findings. | 49 years, Female, Reason: 49 yo female with history of IBS and family hx of UC History: constipation, diarrhea, abdominal cramping. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel wall thickening or abnormal enhancement.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: Left adnexal cyst containing a small amount of hemorrhage measuring 4.3 cm.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel wall thickening or abnormal enhancement.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Normal exam without evidence of inflammatory bowel disease. |
Generate impression based on findings. | Hodgkin lymphoma, nodular sclerosis, s/p 4 cycles of ABVD chemotherapy. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. There are a ground glass opacities in the imaged portions of the lungs. | 1. No evidence of recurrent lymphoma in the neck.2. Ground glass opacities in the imaged portions of the lungs, which may be treatment related or infectious in nature. Please refer to the separate chest CT report for additional details. |
Generate impression based on findings. | Stem cell transplant patient with worsening cough and congestion. There is continued increase in diffuse opacification of the paranasal sinuses with mucosal thickening and fluid. The nasal cavity is also clear. The nasal septum is deviated towards the left. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. The nasopharynx and facial soft tissues appear to be unremarkable. There are bilateral lens implants. There is partial opacification of the left mastoid air cells. There is probable cerumen in the left external auditory canal. There is nonspecific periventricular cerebral white matter hypoattenuation, which may be related to small vessel ischemic disease. | 1. Interval progression of acute sinusitis.2. Partial opacification of the left mastoid air cells may represent mastoiditis. |
Generate impression based on findings. | Reason: Pre-Kidney Transplant, patient has scheduled potential LD Kidney Transplant 3/5/15 had MRA at outside hospital needs additional imaging History: Pre-Kidney Transplant 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.The vertebral arteries are similar in size. The anterior communicating artery is fenestrated. The left A1 segment is slightly smaller than the right A1 segment. The posterior communicating arteries are very very small.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 mucus retention cysts in the left maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for aneurysm.2.No evidence for intracranial cerebrovascular occlusive disease. |
Generate impression based on findings. | 35 years, Female. Reason: possible perforation History: RUQ pain Intrauterine device overlies the midpelvis. GDA embolization coils in the mid upper abdomen. Surgical clip previously seen in the left upper quadrant is now seen in the right lower quadrant.Nonobstructive bowel gas pattern. Lung bases are clear. Supine radiographs are not sensitive for the detection of free air. Within these limitations, no large pneumoperitoneum is evident. | Supine radiographs are not sensitive for the detection of free air. No large pneumoperitoneum. Lateral decubitus images are recommended. Surgical clip previously seen in the left upper quadrant is now seen in the right lower quadrant. |
Generate impression based on findings. | Female 75 years old Reason: altered bowel movement, abdominal pain eval for stool burden and gas pattern History: abdominal pain Nonobstructive bowel gas pattern. Average stool burden. Degenerative changes of the lumbar spine. Bilateral hip prostheses in close to anatomical position. Lung bases are clear. | Nonobstructive bowel gas pattern. Average stool burden. |
Generate impression based on findings. | 11-year-old male with constipation. Rule out fecal impaction.VIEW: Abdomen AP (one view) 2/13/2015. Surgical sutures are again seen in the right lower quadrant. Mild colonic stool burden with no evidence of obstruction. No evidence of pneumoperitoneum, pneumatosis intestinalis, portal venous gas or ascites. | Mild stool burden with no evidence of obstruction or impaction. |
Generate impression based on findings. | Pain status post fall No fracture or malalignment. Suprapatellar joint effusion noted. No significant abnormality is otherwise evident. | Joint effusion, without fracture or malalignment. |
Generate impression based on findings. | Reason: Hoarseness and L SCV adenopathy, evaluate for HN or lung ca History: Hoarseness and L SCV adenopathy, evaluate for HN or lung ca LUNGS AND PLEURA: A spiculated left upper lobe nodule measures up to 19 x 12 mm (series 7, image 38).A spiculated left lower lobe nodule measures 23 x 8 teen millimeters (series 7, image 44).Scattered right lung calcified granulomas.No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is enlarged without pericardial effusion. Moderate coronary artery calcification. The main pulmonary artery measures up to 32 mm, suggestive of pulmonary hypertension.Scattered calcified mediastinal and hilar lymph nodes, from prior granulomatous disease. For reference, a left hilar lymph node measures up to 7 mm in short axis (series 5, image 46).CHEST WALL: A solid nodule within the right breast measures 1.1 x 1.0 cm (series 5, image 51), and appears to have been previously biopsied. Correlate with recent mammographic imaging and physical exam.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Atherosclerotic ossification of the abdominal aorta and its branches. | 1. Two spiculated left lung nodules are highly suspicious for malignancy, likely primary lung cancer.2. Small solid right breast nodule. Correlate with recent mammographic imaging and physical exam. |
Generate impression based on findings. | 30 years, Female. Reason: severe abd pain, eval for free air History: see above Spinal fixation rods and wires are again noted. Bilateral femoral hardware with dysplastic hips unchanged. Rib deformities are unchanged. Ventriculoperitoneal shunt tip projects over the right upper quadrant. Surgical clips are noted along the left paraspinal area. No free intraperitoneal air. Nonobstructive bowel gas pattern. | No free intraperitoneal air. |
Generate impression based on findings. | 26 day old male, ex 28 weeker, with temperature instability, distended abdomen. Evaluate for NECVIEW: Chest and abdomen AP (two views) 2/13/2015 16:01 Feeding tube tip in the stomach. ET tube no longer visualized. UVC catheter no longer seen.Cardiothymic silhouette is normal. Bilateral mild hazy pulmonary opacities. No pleural effusion or pneumothorax.Persistent slightly distended bowel loops with a disorganized bowel gas pattern. Foamy appearance of the bowel gas pattern in the right upper quadrant likely represents stool however pneumatosis intestinalis cannot be excluded. No evidence of obstruction, pneumoperitoneum, portal venous gas or ascites. | 1. Persistent disorganized bowel gas pattern with slightly distended bowel loops not significantly changed. Foamy appearance of the bowel gas pattern in the right upper quadrant likely represents stool although pneumatosis intestinalis cannot be entirely excluded. 2. Persistent bilateral mild hazy opacities. |
Generate impression based on findings. | 68 years, Female. Reason: DHT placement History: DHT replacement ` Enteric tube has been advanced and tip is projected over the anteropyloric region. Nonobstructive bowel gas pattern. Scattered amorphous calcifications projected over the pelvis, likely representing fibroid uterus. Lung bases clear. | Enteric tube with tip projected over the anteropyloric region. |
Generate impression based on findings. | Essential tremor. Evaluate for dopamine dysregulation. Normal symmetric activity is seen in the basal ganglia. | Normal examination. No evidence of nigrostriatal dopaminergic dysfunction. Given the history, these findings are suggestive of essential tremor. |
Generate impression based on findings. | Breast cancer and new hoarseness and left-sided supraclarivular adenopathy. There is no definite evidence of significant left supraclavicular lymphadenopathy, although assessment is limited due to beam-hardening artifact from the adjacent vessels. In addition, there is no evidence of mass lesion or significantly enlarged lymph nodes in the neck. The thyroid and major salivary glands are unremarkable. There is mild plaque at the carotid bifurcations. There is multilevel degenerative spondylosis. The airways are patent. The imaged intracranial structures are unremarkable. There are emphysematous changes in the lungs. | No definite evidence of significant left supraclavicular lymphadenopathy, although assessment is limited due to beam-hardening artifact from the adjacent vessels. |
Generate impression based on findings. | 69 year old female with chronic right flank/abdominal pain, assess for kidney stones, mass, tumor. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Diffusely decreased attenuation of the liver compatible with fatty infiltration. Status-post cholecystectomy. Rim calcified nodule in the gallbladder fossa is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable right renal sinus cysts. Probable rim calcified renal artery aneurysm measures 9 mm in diameter unchanged.RETROPERITONEUM, LYMPH NODES: Stable mildly enlarged retroperitoneal lymph nodes. Reference left periaortic lymph node measures 1.8 x 1.1 cm (series 3, image 65), unchanged.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus absent or atrophicBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis. BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate degenerative changes at the hip joints. | 1.Stable examination. No specific findings to account for patient's pain. 2.Colonic diverticulosis without evidence of diverticulitis. 3.Hepatic steatosis. |
Generate impression based on findings. | Female 48 days old Reason: follow up left lung atelectasis History: respiratory distressVIEW: Chest AP (one view) 2/13/15 at 1619 hrs. NG tube, mediastinal clips and epicardial pacer leads unchanged. Cardiac silhouette size is enlarged but stable. Left upper and lingular opacities, like atelectasis. No effusions or pneumothorax. | Left upper and lingular opacities as described. |
Generate impression based on findings. | Female 62 years old Reason: pain History: anterior shoulder pain. Three views of the right shoulder demonstrate mild degenerative arthritic changes of the glenohumeral joint and acromioclavicular joint. There is no acute fracture or dislocation. There is nonspecific calcification underlying the acromion. Unclear if this is of the acromion.Three views of the left shoulder demonstrate mild degenerative arthritic change glenohumeral joint and acromioclavicular joint. There is no acute fracture-dislocation. | 1.Mild and symmetric osteoarthritis of the bilateral shoulder joints without evidence of acute fracture or dislocation.2.Nonspecific calcification underlying the acromion. Is unclear if this extends off the acromion. MR imaging should be considered if there is asymmetrically increased symptoms in the right shoulder. |
Generate impression based on findings. | Male 21 years old Reason: eval for appendicitis or other intraabdominal process History: periumbilical pain, emesis, leukocytosis ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Normal examination. |
Generate impression based on findings. | Female 62 years old Reason: hand pain History: pain. Three views of the right hand demonstrate minimal osteophyte formation at the base of the metacarpals, proximal , middle, and distal phalanges. There is diffuse mild swelling of the hand without underlying osseous lesion, acute fracture, or dislocation.Three views of the left hand demonstrate minimal osteophyte formation at the base of the metacarpals, proximal common, distal phalanges. There is no acute fracture or dislocation. | Bilateral mild osteoarthritis as described above. |
Generate impression based on findings. | Chronic back pain, lumbar spondylosis, degenerative disk disease. Evaluate areas for inflammatory activity. Need to target a pain generator. Degenerative changes are noted of the right lateral anterior L4-5 vertebral level, including an osteophyte and endplate sclerosis, with associated increased abnormal osteoblastic activity. A smaller focus of increased osteoblastic activity is visualized at the left lateral anterior L5-S1 vertebral level where there is end-plate sclerosis, disc space narrowing and vacuum phenomenon representing degenerative changes. There is relative sparing of the lumbar facets. | Degenerative disc disease with active osteoblastic remodeling of the anterior right lateral L4-5 vertebral bodies and anterior left lateral L5-S1 vertebral bodies to a smaller extent. |
Generate impression based on findings. | PET WB MELANOMA RE-STAGE, 2/13/2015 3:27 PM Today's CT portion grossly demonstrates medium bilateral pleural effusions with overlying compressive atelectasis, left greater than right, with stable size of the left effusion and slightly increased size of the right effusion. There is median sternotomy hardware with postsurgical changes of a coronary artery bypass. A left chest wall ICD is noted along with right axillary surgical clips or calcifications. There is extensive calcific atherosclerotic disease. Status post cholecystectomy. There is bilateral lower extremity soft tissue edema. Today's PET examination demonstrates complete interval resolution of a previously markedly hypermetabolic right upper lateral chest subcutaneous lesion. Right axillary lymph node hypermetabolic activity is also completely resolved. Multiple retroperitoneal, retro-aortic, and iliac lymph nodes have decreased in size and activity: a retro-aortic lymph node (max SUV 3.5, previously 5.2), a left common iliac lymph node (max SUV 2.8, previously 4.3), and a left internal iliac lymph node (max SUV 2.8, previously 3.6). No new FDG avid suspicious lesion is identified. | Significant improvement on therapy with complete resolution of right thoracic activity and partially decreased retroperitoneal and left iliac lymph node activity. Mild residual activity may represent inflammation or mild residual tumor metabolism. No new FDG avid lesion. |
Generate impression based on findings. | Lymphadenopathy on recent previous CT. Rule out primary malignancy.RADIOPHARMACEUTICAL: 12.9 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 62 mg/dL. Today's CT portion grossly demonstrates cholecystectomy clips in the right upper quadrant. Renal scarring is seen bilaterally. A left renal cystic lesion is visualized. Multiple borderline enlarged retroperitoneal and right obturator lymph nodes are seen. Right pelvic surgical clips are noted. Today's PET examination demonstrates a small but significantly hypermetabolically active 1-2 cm right thyroid nodule with an SUVmax activity of 5.1. Several of the enlarged retroperitoneal and pelvic lymph nodes are mildly avid. A left periaortic lymph node at the renal level has an SUVmax of 2.7. A portocaval lymph node also has an SUVmax of 2.7. A right obturator node has an SUVmax of 3.1. A right lower subcentimeter peritracheal lymph node has an SUVmax of 2.7. Otherwise no suspicious FDG avid lesions are seen elsewhere. | 1.Small but significantly hypermetabolic right thyroid nodule, which could represent a benign or malignant thyroid nodule. A thyroid ultrasound with possible biopsy may be obtained for further information if clinically warranted.2.Several slightly enlarged mildly hypermetabolic lymph nodes in the chest, abdomen and pelvis, which may be reactive although neoplastic etiology such as lymphoproliferative disorder cannot be excluded. |
Generate impression based on findings. | 86 year old woman with history of aortic stenosis, heart failure with reduced ejection fraction, pulmonary hypertension who presents for cardiac CT for evaluation prior to possible TAVR.CPT: 75572 Aortic and Aortic Root. There is a left sided aortic arch with normal brachiocephalic branching pattern. There is mild calcification and non-calcified atherosclerosis of the brachiocephalic and left subclavian artery. No thoracic aortic dissection or aneurysm is noted. The thoracic aorta has mild tortuosity. No significant protruding aortic atheroma or thrombus is noted in the thoracic aorta. There is mild calcification of the aortic root. There is moderate calcification of the aortic arch. There is mild calcification of the descending aorta. No aortic coarctation is noted. Aortic Annulus: Dimension: 25mm x 24mm Perimeter: 82mm Area: 4.9cm2Sinus of Valsalva: Width: 33mm x 32mm x 30mm Height: 22mmSinotubular Junction: 27x27mmAscending Aorta (4cm from annulus): 32x32Largest Ascending Ao Diameter: 37x38mmMid Aortic Arch: 28x30mmDescending Aorta: 27x27mmAnnulus to LM Height: 16mmAnnulus to RCA Height: 19mmAortic Leaflet Length:14mmFluoroscopic Angle: LAO 17 CRA15Aortic Valve: The aortic valve is trileaflet. There is moderate to severe aortic valve calcification, which predominantly involves non-coronary coronary cusp. Mitral Valve: Mild mitral annular calcification is noted.Left Ventricle: The left ventricular end-systolic volume is increased. There is no thrombus noted in the left ventricle. There is a mild to moderate sigmoid septum noted. Right Ventricle: Visually the right ventricular end-systolic volume is within normal limits.Left Atrium: The left atrium is moderately dilated. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrium is normal in size. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Pulmonary Artery: Mildly dilated in size (32 mm).Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Coronary arteries: Because heart rate management was not attempted and nitroglycerin was not administered, this exam was not performed to optimally visualize the coronary arteries. However within the limitations of the study the following observations are made:LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There is minimal calcification of the left main coronary artery. LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There is moderate calcification of the LAD. LCx: The left circumflex coronary artery courses normally in the the left AV groove. It gives rise to the obtuse marginal branches and a small AV circumflex branch. There is moderate calcification of the LCx.RCA: The right coronary artery arises normally from the right sinus of Valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There is minimal calcification of the RCA. Coronary Bypass Grafts:None present. | 1. Moderate to Severe aortic valve calcification 2. Thoracic aortic root anatomy as above 3. Moderate overall burden of coronary calcification. 4. Mildly dilated main pulmonary artery. 5. Increased LV end-systolic volume. 6. Moderate left atrial dilation. This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report. The abdominal and pelvis CTA is reported separately. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | MIBG for neuroblastoma staging. Multiple areas of abnormal radiotracer uptake are seen within the left supraclavicular region, the posterior right mediastinum, the distal left paraspinal region, and in a large portion of left retroperitoneum/ left upper abdomen. These areas are grossly similar to the prior examination except for the abdomen which is slightly diminished in size, however, remains markedly MIBG avid. No osseous MIBG avid tumor is identified. Normal physiologic radiotracer distribution is seen in the salivary glands, myocardium, liver, bowel and bladder. | 1. Extensive markedly active MIBG avid tumor of the neck, chest, and abdomen is similar to the prior study though likely slightly improved in the abdomen. 2. No active osseous tumor is identified. |
Generate impression based on findings. | 65 year old woman with history of HTN, paroxysmal atrial fibrillation, severe mitral regurgitation who presents for cardiac CT prior to possible robotic mitral valve surgery CPT: 75572 Aortic and Aortic Root. There is a left-sided aortic arch with normal brachiocephalic branching pattern. There is mild calcification of the brachiocephalic and left subclavian arteries. No thoracic aortic dissection or aneurysm is noted. The thoracic aorta has mild tortuosity. No protruding aortic atheroma or thrombus is noted in the thoracic aorta. There is mild calcification of the aortic root, aortic arch, and descending aorta. No aortic coarctation is noted. Aortic Valve: The aortic valve is trileaflet. There is no aortic valve calcification.Mitral Valve: No mitral annular calcification is noted. There is mild thickening noted of the mitral valve leaflets.Left Ventricle: The left ventricular end-diastolic volume is normal. There is no thrombus noted in the left ventricle. The morphology of the interventricular septum is within normal limits. Right Ventricle: Visually the right ventricular end-diastolic volume is within normal limits.Left Atrium: The left atrium is moderate to severely dilated. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrium is dilated. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Pulmonary Artery: Normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Coronary arteries: Because heart rate management was not attempted and nitroglycerine was not administered, this exam was not performed to optimally visualize the coronary arteries. However within the limitations of the study the following observations are made:LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There is no calcification of the left main coronary artery. LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There is mild calcification of the LAD. LCx: The left circumflex coronary artery courses normally in the the left AV groove. It gives rise to the obtuse marginal branches and a small AV circumflex branch. There is no calcification of the LCx.RCA: The right coronary artery arises normally from the right sinus of Valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There is no calcification of the RCA. Coronary Bypass Grafts:None present. | 1. Minimal coronary calcification. 2. Mild aortic calcification. 3. Significant biatrial dilation.This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax will be interpreted by the attending chest radiologist and included as an addendum to this report. Abdominal/ Pelvic CTA is reported separately. |
Generate impression based on findings. | Male 68 years old Reason: s/p revision reverse L TSA on 2/5/2015 History: above. Components of a reversed total shoulder arthroplasty device are seen situated in near anatomic alignment. Overlying surgical staples and drain are noted. Cardiac conduction device is incompletely imaged on this study. | Postoperative changes reversal shoulder arthroplasty revision as described above. |
Generate impression based on findings. | Preoperative planning for total hip arthroplasty. Hip and groin pain Redemonstration of extensive severe degenerative changes involving both hips mildly greater on the right. Changes include bone-on-bone narrowing, sclerosis and osteophytes with subchondral cysts. Mild flattening of the right femoral head is also observed. No superimposed additional acute abnormality in only mild degenerative changes of the SI joints and symphysis as well the lower lumbar spine (incompletely visualized), are observed.Surrounding musculature and contents the lower pelvis grossly unremarkable yet limited given absence of contrast and collapsed bowel. | Extensive severe degenerative changes of both hips, see description upper |
Generate impression based on findings. | Female 71 years old Reason: pre-op mako systyem left uni arthroplasty History: pain. There is near severe degenerative changes of the left knee joint, greatest in the medial tibiofemoral compartment. There is associated sclerosis of the distal femur and proximal tibia and subchondral cysts. There are tricompartmental osteophytes. The remaining surrounding soft tissues are unremarkable. There is a small patellar joint effusion. | Severe osteoarthritis of the left knee as described above. |
Generate impression based on findings. | Female 69 years old Reason: Dx GCT femur with curretage and cementation History: Eval No no lytic lesions. Patient is status post curettage and cementation of the medial femoral condyle which appears homogenous and well defined without surrounding lucency. The surrounding soft tissues are unremarkable. The muscles are within normal limits. | Status post curettage and cementation of the left medial femoral condyle without complication. |
Generate impression based on findings. | History of PTLD/Hodgkin's subtype status post 6 cycles of ABVD now with apparent relapse of disease in need of staging PET scan.RADIOPHARMACEUTICAL: 15.1 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 102 mg/dL. Today's CT portion grossly demonstrates a left maxillary sinus retention cyst. There is a ill-defined hypoattenuating lesion within the right hepatic lobe. There are post-surgical changes of a right renal resection and a right pelvic renal transplantation. The left kidney is atrophic. There is a sclerotic focus within the right iliac bone. Today's PET examination demonstrates a new large markedly hypermetabolic focus centered in the right scapula (max SUV of 33.0). Another new hypermetabolic focus is seen in the right paraspinal musculature at the mid-thoracic level (max SUV of 7.9). A new markedly hypermetabolic lesion is identified in the posterior right hepatic lobe (max SUV of 10.8). A markedly hypermetabolic focus in the muscle just lateral to the left iliac wing is also new from the previous exam (max SUV of 15.5). Multiple small hypermetabolic lymph nodes are noted in the left neck and upper abdomen, most notably a portocaval lymph node (max SUV of 4.7), are new from the prior examination and indicate additional tumor. | Progression of tumor with numerous new markedly hypermetabolic lesions including liver, intramuscular, and osseous sites as well as involvement of lymph nodes in the neck and abdomen. |
Generate impression based on findings. | Female 40 years old with increasing pain recently with a baseball-sized thoracolumbar in multiple mass. Three views of the thoracic spine demonstrate preservation of the normal vertebral body heights and intravertebral disk spaces. There is no acute fracture or subluxation. Alignment is preserved. There is no evidence of bony neural foraminal stenosis. A nonspecific round mass is seen in the posterior soft tissues at the lower thoracic/upper lumbar area which does not appear osseous in origin.Five views of the lumber spine demonstrate preservation of the normal vertebral body heights and intravertebral disk spaces. There is no acute fracture subluxation. Alignment is preserved. Is no evidence of bony neural foraminal stenosis. As described above is a round mass in the posterior soft tissues at the lower thoracic/upper lumbar area which does not appear osseous in origin. | Soft tissue mass without evidence of impingement on the thoracolumbar spine. |
Generate impression based on findings. | Echogenic mass is noted corresponding to mass seen in segment 4/8 on prior MRI. The mass abuts, and is indistinguishable from middle hepatic vein wall in a very small portion of the vein, however there is no evidence of extension of the mass into the lumen.The catheter was removed and hemostasis was achieved.CHEMOEMBOLIZATION:The right common femoral artery was punctured with a micropuncture system and over an 0.035 wire, a 5 French sheath was placed. A 5 French pigtail catheter was advanced over the wire and to the lower abdominal aorta and abdominal aortogram with was performed. The superior mesenteric artery was then selected with and RC1 catheter and a selective arteriogram was performed. The celiac trunk was then selected and a selective arteriogram was performed. AORTOGRAM: Normal caliber aorta with no evidence of stenosis or aneurysm. Normal appearing single bilateral renal arteries. Patent celiac trunk, SMA and IMA.CELIAC ANGIOGRAM: Patent splenic, left gastric and common hepatic arteries. No accessory or replaced left hepatic artery was seen.SMA ANGIOGRAM: Patent vessels without evidence of a replaced or accessory right hepatic artery. In the portal venous phase, a patent portal vein was noted. With the aid of a guidewire the common hepatic artery was selected and a selective arteriogram was performed.HEPATIC ARTERY ANGIOGRAM: Patent left and right hepatic arteries. A tumoral blush was identified arising from the right and left hepatic arteries. The right hepatic artery was then selected with a microcatheter and selective arteriogram was performed.SELECTIVE RIGHT HEPATIC ARTERY ANGIOGRAM: There is tumor blush without significant portal venous shunting. This artery was then further selected downstream with a Renegade Hi-Flow catheter and superselective a arteriogram was performed.SUPERSELECTIVE RIGHT HEPATIC ARTERY ANGIOGRAM: Tumor blush is confirmed arising from this vessel.This vessel was chemoembolized with 25mg of Epirubicin and 2 ml of Ethiodol mixed in one vial of Quadraspheres. Approximately 25% of the prepared chemotherapy dose was administered. Post-embolization angiography was then obtained.POST-EMBOLIZATION ANGIOGRAPHY: Near stasis within the embolized distribution with sparing of the remaining hepatic vessels.The segment IV branch of the left hepatic artery was then selected with a microcatheter and selective arteriogram was performed.SELECTIVE LEFT HEPATIC ARTERY ANGIOGRAM: There is tumor blush without significant portal venous shunting. This vessel was chemoembolized with 25mg of Epirubicin and 2 ml of Ethiodol mixed in one vial of Quadraspheres. Approximately 50% of the prepared chemotherapy dose was administered. Post-embolization angiography was then obtained.POST-EMBOLIZATION ANGIOGRAPHY: Near stasis within the embolized distribution with sparing of the remaining hepatic vessels.Right common femoral angiogram was performed demonstrating patent right common femoral artery. The sheath was removed and hemostasis was achieved with Angio-seal closure device.The patient tolerated the procedure well without immediate complication. Routine post procedure instructions were documented in the chart and relayed to the referring clinical team.FLUOROSCOPY TIME: 36.8 MinutesAIR KERMA: 628.69 mGyESTIMATED BLOOD LOSS: Less than 5cc. | 1. Venogram and IVUS of the middle hepatic vein demonstrates mass abutting, and indistinguishable from the vein wall in a small portion of the vein wall. There is no evidence of extension of the mass into the lumen.2. Successful chemo-embolization of segment IV/VIII tumor. PLAN: Admit to medical service for observation. Recommend repeat cross sectional imaging in 6-8 weeks, followed by repeat chemoembolization/thermoablation, as warranted. |
Generate impression based on findings. | Three-year-old female with history of finger laceration. There is soft tissue swelling and laceration along the distal aspect of the middle phalanx. There is a punctate density along the medial/proximal aspect of the distal phalanx which may represent a tiny avulsion fracture (Salter-Harris 3). Cortical irregularity along the distal aspect of the distal phalanx best seen on the oblique view may represent a small fracture, although this is equivocal. No evidence of radiopaque retained foreign object. | 1.Soft tissue laceration as above.2.Possible Salter-Harris 3 fracture of the third distal phalanx. Follow-up radiographs may be obtained in 10 to 14 days if clinically warranted.3.No evidence of radiopaque retained foreign object. |
Generate impression based on findings. | 66 year old female with abdominal pain. Within the limits of a non IV contrast enhanced examination which limits the ability to evaluate solid parenchymal organs and vascular structures, the following observations can be made: ABDOMEN:LUNG BASES: Partially visualized central venous catheter with tip at the SVC atrial junction. Moderate coronary calcifications. Small left pleural effusion and trace right pleural effusion, new from prior. LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Microscopic fat containing right adrenal lesion compatible with a myelolipoma. KIDNEYS, URETERS: There is a large left retroperitoneal dense fluid collection (62 HU) extending from the posterior-inferior aspect of the left kidney within the perirenal space and displacing the left kidney anteriorly compatible with a large hematoma measuring approximately 7 x 12 cm. Comparison with the prior exam reveals no obvious intrinsic abnormality to explain this hematoma.Right renal upper pole cystic lesion appearing grossly similar to prior but incompletely evaluated without intravenous contrast. RETROPERITONEUM, LYMPH NODES: See above. No retroperitoneal lymphadenopathy. Severe atherosclerotic calcification of the abdominal aorta and its branches. BOWEL, MESENTERY: Diverticulosis without evidence of acute diverticulitis. Appendicolith at the base of an otherwise normal appendix.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Leiomyomatous uterus.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of the spine most pronounced at L5-S1 where there is severe degenerative disk disease.OTHER: No significant abnormality noted | 1.Large left perinephric hematoma. Comparison with the prior exam reveals no obvious intrinsic abnormality to explain this hematoma. Without intravenous contrast, unable to assess for active bleeding. 2.New small left pleural effusion.3.Cholelithiasis. 4.Appendicolith which may place patient at increased risk of developing appendicitis in the future. |
Generate impression based on findings. | 35 year-old female with pancreatic cancer now with right upper quadrant pain, evaluate for ischemia versus perforation. ABDOMEN:LUNG BASES: Partially visualized central venous catheter with tip at the SVC right atrial junction.LIVER, BILIARY TRACT: Subcentimeter hypoattenuating lesion in hepatic segment 5/6 is too small to characterize (series 3, image 63) but appears similar to the prior exam.The gallbladder is distended and is surrounded by ascitic fluid, cannot exclude acute cholecystitis. There is mild intra-hepatic biliary ductal dilatation as well as mild common bile duct dilation, increased from prior and likely related to patient's pancreatic mass.SPLEEN: New small splenic infarcts are present.PANCREAS: Again visualized a large mass in the region of the head/body of the pancreas extending into the uncinate process. This lesion measures approximately 3.5 x 5.2 cm (series 3, image 67), previously 3.5 x 5.2 cm. There is encasement of the celiac, hepatic, splenic and superior mesenteric arteries. The portal vein is occluded, with cavernous transformation of portal vein evident. There is attenuation of the SMV near the confluence. The splenic vein is occluded, with numerous perigastric varices evident.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Scattered subcentimeter retroperitoneal lymph nodes are not pathologically enlarged by size criteria.BOWEL, MESENTERY: Loss of the fat plane between the pancreas and antrum of the stomach suggests possible invasion. No evidence of bowel obstruction or perforation.BONES, SOFT TISSUES: Unchanged sclerotic focus in the L4 vertebral body.OTHER: New moderate abdominopelvic ascites. PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No evidence of bowel obstruction or perforation.BONES, SOFT TISSUES: Unchanged sclerotic focus in the L4 vertebral body.OTHER: New moderate abdominopelvic ascites. | 1.Pancreatic head/body mass as detailed above, with extensive vascular encasement. 2.The gallbladder is significantly distended raising the question of cholecystitis. Recommend ultrasound for further evaluation. 3.Interval development of mild biliary ductal dilatation likely related to pancreatic mass. 4.Interval development of moderate abdominopelvic ascites.5.New small splenic infarcts.6.No evidence of pneumoperitoneum or bowel obstruction. |
Generate impression based on findings. | 51 year-old female with vomiting, abdominal pain, and leukocytosis. Within the limits of a non IV contrast enhanced examination which limits the ability to evaluate solid parenchymal organs and vascular structures, the following observations can be made: ABDOMEN:LUNG BASES: Small pericardial effusion, increased from prior. Mild coronary artery calcifications.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Atrophic native kidneys. Transplant kidney in the right iliac fossa, without perinephric inflammatory changes, hydronephrosis or hydroureter, or calculi. No peritransplant fluid collection.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Dilated, fluid-filled endometrial cavity which is abnormal in a postmenopausal patient.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No evidence of bowel obstruction or appendicitis. 2.Small pericardial effusion, increased from prior. 3.Atrophic native kidneys. Unchanged appearance of renal transplant in the right iliac fossa. 4.Dilated, fluid filled endometrial cavity in postmenopausal patient, recommend pelvic ultrasound/gynecologic consultation for further evaluation. |
Generate impression based on findings. | 23 year old female with right lower quadrant pain, evaluate for ischemia. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. Appendix well visualized and unremarkable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: There are multiple, oval-shaped high attenuation lesions which appear to reside within the bilateral adnexa. An example lesion in the left adnexa (series 3, image 96) measures 6.1 x 4.3 cm. Both adnexa are enlarged, and the left adnexa it is considerably larger than the right. Differential diagnosis includes multiple hemorrhagic cysts and neoplasm with or without superimposed adnexal torsion. There is trace surrounding pelvic fluid/stranding.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. Appendix well visualized and unremarkable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Multiple bilateral high attenuation adnexal lesions and significant asymmetric enlargement of the left adnexa. Differential diagnosis includes multiple hemorrhagic cysts or neoplasm with or without superimposed adnexal torsion. Pelvic ultrasound is recommended for further evaluation. Findings discussed by on call resident with Dr. Soto at 8:25 p.m. on 2/13/2015. |
Generate impression based on findings. | 30-year-old female with abdominal pain and vomiting. 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: Metallic streak artifact from thoracolumbar spinal fusion hardware somewhat limits evaluation. LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Chronic osseous changes likely related to patient's history of osteogenesis imperfecta. Orthopedic thoracolumbar spinal fusion device appearing similar to prior.OTHER: Shunt catheter courses along the right anterior abdominal wall and then enters the peritoneal cavity with tip near the hepatic hilum. Small amount of abdominopelvic ascites without CSF pseudotumor, similar to prior. PELVIS:UTERUS, ADNEXA: There is an incompletely characterized 4.8 x 4.2 cm right adnexal cystic lesion (series 4, image 63) with internal decreased density appearing similar to prior. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Orthopedic thoracolumbar spinal fusion device and bilateral femoral orthopedic devices, similar to prior. OTHER: Small amount of abdominopelvic ascites, similar to prior. | 1.No specific evidence of shunt malfunction.2.Small amount of abdominopelvic ascites, similar to prior. 3.Incompletely characterized right adnexal cystic lesion, similar to prior. |
Generate impression based on findings. | 20 year-old female with fever and UTI, evaluate for pyelonephritis. 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: The right kidney demonstrates a striated nephrogram and surrounding asymmetric mild fat stranding compatible with acute pyelonephritis. Tiny punctate calcifications are present with the right kidney compatible with vascular calcifications or tiny nonobstructing calyceal calculi. No obstructing calculi or hydronephrosis. No drainable fluid collections.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of free fluid in the pelvis which can be physiologic. | Right pyelonephritis. No associated hydronephrosis or abscess. |
Generate impression based on findings. | 66 year old woman with abdominal pain. Intravenous contrast extravasation. CT images with intravenous contrast were not acquired. Patient to be credited for exam. Please see subsequent exam without intravenous contrast. | Intravenous contrast extravasation. CT images with intravenous contrast were not acquired. Patient to be credited for exam. Please see subsequent exam without intravenous contrast. |
Generate impression based on findings. | 77 year old male with history of obstructing renal stones, CKD, now with worsening renal failure of unclear etiology. 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: LUNG BASES: Coronary calcifications. Fat deposition within the apex and intraventricular septum with mild focal aneurysmal dilatation of the left ventricle, likely a sequela of prior infarct, similar to prior. LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Splenic granuloma. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Previously seen proximal left ureteral stone is no longer present. Punctate nonobstructive calyceal calculi are present in the left kidney. No hydronephrosis or obstructing renal calculi. Left renal cyst and right peripelvic cyst appear similar to prior. RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcifications of the abdominal aorta and its branches. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate degenerative changes of the thoracolumbar spine, similar to prior. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Punctate non-obstructing left calyceal calculi without obstructing calculi or hydronephrosis. 2.Fat deposition within the apex and intraventricular septum with mild focal aneurysmal dilatation of the left ventricle, likely a sequela of prior infarct, similar to prior. |
Generate impression based on findings. | 57-year-old male with sepsis and anemia, evaluate for intra-abdominal bleeding. ABDOMEN:LUNG BASES: Bilateral small pleural effusions with attenuation of simple fluid. LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter present with tip in collapsed bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No specific evidence of intra-abdominal infection or hemorrhage.2.Bilateral small pleural effusions. |
Generate impression based on findings. | Male 4 years old Reason: Fracture History: Pain, erythema, difficulty ambulatingVIEWS: Left foot AP lateral 2/14/15 (two views) Soft tissue swelling with no fracture, malalignment or joint effusion. | Soft tissue swelling but no fracture. |
Generate impression based on findings. | 5-year-old male, evaluate for pneumoniaVIEW: Chest AP (one view) 2/13/15 17:17 The cardiothymic silhouette is normal. Mild bronchial wall thickening suggests reactive airway disease or bronchiolitis. No evidence of pneumonia. | Bronchiolitis or reactive airway disease without evidence of pneumonia. |
Generate impression based on findings. | 3-day-old male premature with difficulty breathingVIEW: Chest AP (one view) 2/14/15 5:29 Endotracheal tube tip just below the thoracic inlet. NG tube side port at GE junction. UAC catheter tip at T7. The cardiothymic silhouette is normal.Diffuse bilateral pulmonary opacities are not significantly changed. No pneumothorax. | Unchanged pulmonary opacities without pneumothorax. |
Generate impression based on findings. | Right heart failure. Evaluate for PE. PULMONARY ARTERIES: No evidence of pulmonary embolism.LUNGS AND PLEURA: Calcified lung nodules consistent with healed granulomatous disease.No pleural effusion or focal airspace consolidation.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion.Moderate coronary artery calcification. Mitral annulus calcification.Moderately enlarged noncalcified mediastinal lymph nodes, likely reactive. Calcified mediastinal lymph nodes consistent with healed granulomatous disease.CHEST WALL: No axillary lymphadenopathy. Median sternotomy.Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cirrhotic liver morphology. Small amount of abdominal ascites. Calcified splenic granuloma. Cholecystectomy clips. | No evidence of pulmonary embolism. Moderate coronary artery calcification. Cirrhotic liver morphology and small amount of ascites. No other significant abnormality. PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Shortness of breath, tachycardia. Pregnant. PULMONARY ARTERIES: Examination is diagnostic to the segmental arterial level with no pulmonary embolism identified. LUNGS AND PLEURA: No focal airspace consolidation or pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.No visible coronary artery calcification.Normal heart size without pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hepatomegaly. | No evidence of pulmonary embolism to the segmental level. No other significant acute abnormality. PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 3-day-old male with worsening respiratory statusVIEW: Chest AP (one view) 2/13/1517:50 Endotracheal tube tip below the thoracic inlet. NG tube side-port at the GE junction. UAC catheter at T6. Diffuse bilateral hazy pulmonary opacities appear similar to the prior exam. No pneumothorax. The cardiothymic silhouette is unchanged. | Diffuse pulmonary opacities appear similar to the prior exam. |
Generate impression based on findings. | 90 year-old female with abdominal pain and constipation. ABDOMEN:LUNG BASES: Mild cardiomegaly. Subtle area of relatively decreased attenuation in the descending right pulmonary artery is thought to represent artifact rather than pulmonary embolism. Mild basilar scarring/atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcifications affect the abdominal aorta and its branches.BOWEL, MESENTERY: The proximal small bowel is dilated up to 3.5 cm with a probable transition located in the right lower quadrant (series 3, image 89) with collapse of small bowel distally compatible with high grade small bowel obstruction. Colonic diverticulosis. BONES, SOFT TISSUES: Moderate degenerative changes of the visualized osseous structures.OTHER: Mild abdominopelvic ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The proximal small bowel is dilated up to 3.5 cm with a probable transition located in the right lower quadrant (series 3, image 89) with collapse of small bowel distally compatible with high grade small bowel obstruction. Colonic diverticulosis. BONES, SOFT TISSUES: Moderate degenerative changes of the visualized osseous structures.OTHER: Mild abdominopelvic ascites. | 1.High-grade small bowel obstruction likely due to adhesions.2.Mild abdominopelvic ascites.3.Colonic diverticulosis. |
Generate impression based on findings. | 6-year-old female with cough and decreased breath soundsVIEWS: Chest AP/lateral (two views) 2/13/15 18:23 The cardiothymic silhouette is normal. Bronchial wall thickening and right middle and basilar subsegmental atelectasis. No pneumothorax. | Bronchiolitis or reactive airway disease with superimposed right middle lobe subsegmental atelectasis. |
Generate impression based on findings. | 70 year old female with history of breast cancer, evaluate for metastases. ABDOMEN:LUNG BASES: Please see chest CT from same day for full details regarding the chest. LIVER, BILIARY TRACT: Numerous low attenuation lesions are present in both hepatic lobes which are new from the 2005 exam and are compatible with metastases. An example lesion in segment 7 (series 12, image 39) measures 2.4 x 2.4 cm.The gallbladder is collapsed. No biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal simple cyst with additional bilateral low-attenuation lesions too small to characterize but likely benign.RETROPERITONEUM, LYMPH NODES: Subcentimeter retroperitoneal lymph nodes are nonspecific.BOWEL, MESENTERY: No evidence of bowel obstruction or intraperitoneal free air. Colonic diverticulosis.BONES, SOFT TISSUES: Widespread osseous metastases are present in the visualized ribs, spine, and pelvis. Multiple thoracolumbar pathologic compression fractures appear similar to recent MRI.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Approximately 3 cm left adnexal soft tissue nodule incompletely characterized. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No evidence of bowel obstruction or intraperitoneal free air. Colonic diverticulosis.BONES, SOFT TISSUES: Widespread osseous metastases are present in the visualized ribs, spine, and pelvis. Multiple thoracolumbar pathologic compression fractures appear similar to recent MRI.OTHER: No significant abnormality noted | 1.Please see chest CT from same day for full details regarding the chest. 2.Hepatic metastases. 3.Diffuse osseous metastases. Pathologic compression fractures in the lower thoracic and lumbar spine appear similar to recent MRI. |
Generate impression based on findings. | Male 13 days old Reason: interval change History: persistent desaturation, agitationVIEW: Chest AP and abdomen (two views) 2/13/15 at 2043 hrs. ET tube terminates below thoracic inlet. NG tube tip is at the stomach. Right upper extremity central line tip is at the right subclavian/innominate vein junction.Cardiac silhouette size is top normal or mildly enlarged but stable. Right lung base opacity and right-sided pleural effusion unchanged.Slightly featureless , nonspecific bowel loops noted. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Persistent right lung base opacity right-sided pleural effusion.Interval repositioning of central line.Slightly featureless , nonspecific bowel loops noted. |
Generate impression based on findings. | 56 female history of Crohn's disease now with abdominal pain and obstipation. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is a low-attenuation lesion within the left hepatic lobe, unchanged since 2012 and likely a benign cyst.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral simple renal cysts, not significantly changed.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of prior ileocecectomy. No evidence of small bowel obstruction. The small bowel is poorly distended. Within this limitation, no specific evidence of active Crohn's disease. The distal colon is filled with stool, somewhat increased from prior.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical changes of prior ileocecectomy. No evidence of small bowel obstruction. The small bowel is poorly distended. Within this limitation, no specific evidence of active Crohn's disease. The distal colon is filled with stool, somewhat increased from prior.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Postsurgical findings related to prior ileocecectomy. 2.Evaluation of the small bowel somewhat limited by lack of distention. Within this limitation, no specific evidence for active Crohn's disease. No small bowel obstruction. 3.Colon distended with stool, increased from prior. |
Generate impression based on findings. | 8-year-old female with pain, fell on concrete while runningVIEWS: Left knee, AP and lateral (two views) 2/14/15 4:18 Alignment is anatomic. No fracture or joint effusion. | Normal examination. |
Generate impression based on findings. | Male 3 months old Reason: reeval lung fields History: Acute respiratory distress.VIEW: Chest AP (one view) 2/14/15 at 405 hours. ET tube terminates below thoracic inlet. NG tube tip is in the stomach. Right upper extremity central line tip is at the SVC/right atrium. Cardiac silhouette size is top normal or mildly enlarged, but stable. Improvement in right upper and lower lobe opacities, left retrocardiac atelectasis unchanged. | Interval improvement in right lung aeration as described. |
Generate impression based on findings. | Noncontrast head CT: Multiple foci of low attenuation in the right cerebral hemisphere correlate with areas of acute infarction on prior MRI, superimposed upon age-indeterminate small vessel ischemic disease. There is no acute intracranial hemorrhage, mass-effect, or midline shift There are extensive calcifications in the imaged portions of the vertebral, basilar, and internal carotid arteries. The calvarium is unremarkable without fracture. The imaged portions of the orbits, paranasal sinuses, and mastoid air cells are unremarkable. CTA brain: There is extensive atherosclerotic calcification of the internal carotid arteries, right greater than left. On the right there is moderate-severe stenosis of the cavernous, clinoid, and supraclinoid segments of the right internal carotid artery. There is relatively mild ICA stenosis on the left. The right posterior communicating artery is visualized, and the left posterior communicating artery is not clearly opacified. There is asymmetrically decreased opacification of distal middle cerebral artery branches on the right. Both anterior cerebral arteries are patent, with a third anterior branch arising from the anterior communicating artery. There are multiple areas of moderate posterior cerebral artery stenosis more prominent on the right. There is dense calcification of the right vertebral artery resulting in moderate stenosis. There is mild atherosclerosis of the left vertebral artery without significant stenosis. There is no evidence of intracranial aneurysm. | 1. Extensive small vessel ischemic disease with multifocal infarcts in the right MCA and PCA distributions which are better appreciated on prior MRI. No acute intracranial hemorrhage or edema. 2. Marked intracranial atherosclerotic disease as described above, most severely affecting the right internal carotid artery, right vertebral artery, and right MCA and PCA distributions. |
Generate impression based on findings. | 63 year-old female with history of fallopian tube cancer now with nausea, vomiting, and diarrhea; evaluate for obstruction or malignancy. ABDOMEN:LUNG BASES: Emphysema.LIVER, BILIARY TRACT: Again seen is fatty infiltration of the liver with some areas of sparing. No suspicious focal lesions. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Retroperitoneal surgical clips. No significant lymphadenopathy. Mild atherosclerotic calcifications of the abdominal aorta. BOWEL, MESENTERY: There is mild multifocal dilation of several loops of small bowel, increased from prior. Contrast, however, is present in the distal small bowel which is not completely collapsed. These findings together are most consistent with chronic multifocal, mild partial small bowel obstruction. No intraperitoneal free air.BONES, SOFT TISSUES: Postsurgical changes to the anterior abdominal wall are noted. Degenerative changes of the thoracolumbar spine are present.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Surgically absent. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: There is mild multifocal dilation of several loops of small bowel, increased from prior. Contrast, however, is present in the distal small bowel which is not completely collapsed. These findings together are most consistent with chronic multifocal, mild partial small bowel obstruction. No intraperitoneal free air.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine are present.OTHER: Trace amount of pelvic free fluid. | 1.Findings suggestive of chronic, multifocal mild partial small bowel obstruction.2.No new metastatic disease identified.3.Cholelithiasis. |
Generate impression based on findings. | Dislocation status post reduction There is been interval reduction of the prior left shoulder anterior dislocation, now in anatomic alignment. A moderate sized Hill-Sachs deformity is present. There is indistinctness at the inferior aspect of the glenoid, which may represent a Bankart lesion. | Left shoulder reduction, as above. |
Generate impression based on findings. | 33 year old female with history of hypoglycemia syndrome. Arterial phase images somewhat limited by patient motionABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is a hepatic lesion in segment 4a (series 10, image 34) which measures 1.3 x 0.8 cm. The lesion demonstrates discontinuous peripheral nodular enhancement but does not completely follow the blood pool on the more delayed images. Though this lesion may represent a hemangioma, the appearance is somewhat atypical, and the lesion is best considered indeterminant.No biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No focal pancreatic lesions.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Trace amount of free fluid which may be physiologic | 1.No evidence of pancreatic lesions.2.Segment 4A hepatic lesion which may represent an atypical hemangioma but is best considered indeterminant. MRI may be helpful for further evaluation. |
Generate impression based on findings. | Male 3 months old Reason: eval prior to extubation History: intubated, respiratory failure.VIEW: Chest AP (one view) 2/14/15 at 429 hours. ET tube terminates below thoracic inlet. NG tube tip is in the stomach. Cardiac silhouette size is normal. Right upper lobe streaky opacity, likely subsegmental atelectasis. | Subsegmental atelectasis of the right upper lobe. |
Generate impression based on findings. | New head and neck cancer. Evaluate for metastases. CHEST:LUNGS AND PLEURA: Mild upper lobe paraseptal emphysema and minimal centrilobular emphysema.No suspicious pulmonary nodules or masses are identified.Mild dependent atelectasis.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.No visible coronary artery calcification. Mild calcification of the thoracic aorta.Heart size is top normal to mildly enlarged without pericardial effusion.Tracheostomy tube tip is 6 cm above the carina. Trace subcutaneous emphysema in the neck, presumably post-procedural.CHEST WALL: Bilateral gynecomastia.Round well-defined sclerotic focus in the left medial clavicular head is likely a benign bone island.Minimal degenerative changes of the thoracolumbar spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: 10 x 13 mm right hepatic lobe hypodense lesion with peripheral nodular foci of enhancement (series 5, image 81), likely a hemangioma though incompletely characterized on this single phase exam.Calcified hepatic granulomata.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: Severe calcified atherosclerotic disease of an ectatic abdominal aorta and its branch vessels with mural thrombus. No lymphadenopathy.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. | 13 mm liver lesion is likely benign though indeterminate; MRI w/wo contrast would be helpful for further characterization. No other lesions suspicious for metastasis are identified. |
Generate impression based on findings. | 3-day-old male with increasing ventilatory requirementsVIEW: Chest AP (one view) 2/14/15 5:35 ETT tip just above the carina. UVC catheter tip at the junction of the SVC and right atrium. UAC catheter at T6. The cardiothymic silhouette is normal.New right upper lobe opacity and persistent bilateral hazy opacities. | New focal right upper lobe opacity and continued diffuse bilateral hazy opacities. UVC catheter tip at the junction of the SVC and right atrium. |
Generate impression based on findings. | Edema. Right arm swelling. There is mild subcutaneous edema throughout the forearm. No specific etiology for this edema is evident on this examination. No loculated fluid collection is seen to suggest abscess formation.No fracture or malalignment is present. Chondrocalcinosis is present at the radiocarpal joint. Mild degenerative changes are noted in the elbow. | Mild diffuse subcutaneous soft tissue edema of the forearm, without specific etiology evident. |
Generate impression based on findings. | Female 49 days old Reason: Interval changes in atelectasis History: s/p cardiac surgeryVIEW: Chest AP (one view) 2/14/15 at 542 hours. Epicardial pacer leads, NG tube and mediastinal clips unchanged. Cardiac silhouette size is top normal or mildly enlarged, but stable. Slight improvement in left lung aeration. Streaky opacity, likely subsegmental atelectasis of the left lower lobe noted. | Slight improvement in left lung aeration as described. |
Generate impression based on findings. | 8-year-old male with pain, rule out foreign bodyVIEWS: Right foot, AP, oblique, and lateral (3 views) 2/14/15 8:08 No radiopaque foreign body. Alignment is anatomic. The osseous structures appear normal for the patient's age. | No fracture or radiopaque foreign body. |
Generate impression based on findings. | Male 27 days old Reason: ?NEC History: Abd distensionVIEW: Abdomen and chest AP (two views) 2/14/15 at 550 hours. NG tube terminates above GE junction. Cardiac silhouette size is normal. No focal lung opacities, effusions or pneumothorax.Disorganized, nonspecific abdominal gas pattern. No evidence of obstruction, free air, pneumatosis intestinalis or portal venous gas. | Misplaced NG tube.Improvement in abdominal gas pattern with persistent disorganization. |
Generate impression based on findings. | Pain and abrasion over the posterior left first metacarpal. Pain and swelling over the distal right ulna. History of fall one day prior. LEFT HAND: The bones are demineralized. Mild osteoarthritic changes are present in the basal joint and DIP joints. No fracture or malalignment is present.RIGHT WRIST: There is soft tissue swelling over the volar distal forearm and wrist, without elevation of the pronator quadratus fat pad. The bones are demineralized. Mild degenerative changes are present in the basilar joint. Scaphoid deformity may represent prior injury. No acute fracture or malalignment is present. | No fracture or malalignment |
Generate impression based on findings. | Unstageable left decubitus ulcer. The bones are demineralized. Gas projects over the posterolateral proximal left thigh, compatible with ulceration, without clear extension of gas to the underlying femur. There is no radiographic evidence of osteomyelitis.Mild degenerative changes affect the left hip. Vascular calcifications are noted. | Soft tissue ulceration, without radiographic evidence of osteomyelitis. Serial imaging may increase sensitivity for osteomyelitis. |
Generate impression based on findings. | There is right frontal scalp contusion with small foci of soft tissue gas without skull fracture. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There are moderate periventricular and subcortical foci of hypoattenuation, unchanged. The ventricles and basal cisterns are prominent but unchanged consistent with diffuse volume loss. There is no hydrocephalus. There is no midline shift or herniation. There are dense bilateral cavernous internal carotid and bilateral V4 vertebral artery segment atherosclerotic calcifications. There are mucus retention cysts in both maxillary sinuses, and the left sphenoid sinus. There is scattered ethmoid sinus mucosal thickening and mild left frontal sinus mucosal thickening. The degree of mucosal thickening in the left sphenoid sinus has decreased from prior exam. There is osseous graft material and screws transfixing the lateral masses of C1 posteriorly, unchanged. The skull and extracranial soft tissues are otherwise unremarkable. | Small right frontal scalp soft tissue contusion/laceration with no acute intracranial hemorrhage or skull fracture. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Fall. Back pain. C-SPINE: Anterior fusion is again seen at C4-C7, unchanged. The alignment is anatomic. The vertebral body heights are preserved and unchanged. No prevertebral soft tissue swelling is present.T-SPINE: Decompressive laminectomies at T8 and T9 are again seen. The alignment is anatomic. The vertebral body heights are preserved and unchanged.L-SPINE: L4 through S1 posterior surgical fusion is again seen, with unchanged anterolisthesis of L4 on L5. The vertebral body heights are preserved. The mild lucency around the L4 pedicle screws is similar to prior studies. | Postoperative changes, without evidence of acute injury. |
Generate impression based on findings. | Female, 74 years old, with altered mental status and history of left ICA stenosis and brainstem infarct, possible subacute stroke. Assess for steno-occlusive disease. Non-angiographic findings:Again seen is extensive ill-defined periventricular hypoattenuation with more focal lucent lesions in the basal ganglia, right side more than left. Focal lucency is also evident within the brainstem. There has been no significant interval change since the prior study. No new mass-effect or edema is detected. No acute intracranial hemorrhage is seen. Ventricles are stable in size and morphology.Several nonspecific hypoattenuating nodules are seen within the thyroid.Angiographic findings:Common origin of the brachiocephalic and left common carotid arteries is seen. Origns of the great vessels are patent. Mild atherosclerotic narrowing at the carotid bifurcations is seen without significant stenosis by NASCET criteria. The carotid and vertebral vessels of the neck are free of significant stenoses.Moderate calcified atherosclerotic disease affects the cavernous ICAs but without significant high-grade stenosis. Likewise mild atherosclerotic calcification affects the V4 segments of the intracranial vertebral arteries but without significant stenosis.Scattered mild to moderate focal areas of vascular stenosis are suspected within the distal ACA and MCA territories. A high-grade focal stenosis is seen within the P2 segment of the left PCA. No aneurysms are detected within the limitations of technique. | 1. Precontrast imaging redemonstrates extensive age indeterminate microvascular ischemic disease and scattered prior lacunar infarctions.2. No high grade vascular stenosis or occlusion is seen within the neck.3. Moderate atherosclerotic narrowing of the cavernous ICAs is seen. Mild to moderate focal stenoses are detected within the distal ACA and MCA territories. A fairly high-grade stenosis is seen within the P2 segment of the left PCA.4. Several nonspecific thyroid nodules are identified for which further evaluation by ultrasound may be considered if warranted. |
Generate impression based on findings. | Breast cancer. Evaluate for PE. PULMONARY ARTERIES: No evidence of pulmonary embolism.LUNGS AND PLEURA: Numerous small flat nodules along the fissures bilaterally are consistent with intrapulmonary lymph nodes; while normal in morphology, the number of nodes is more than usual and metastatic disease cannot be excluded.Calcified lung nodules consistent healed granulomatous disease. Scattered scarlike opacities.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Calcified left hilar lymph node consistent with healed granulomatous disease.Normal heart size without pericardial effusion.No visible coronary artery calcification.CHEST WALL: Large right breast ulceration with an underlying mass consistent with known breast malignancy.Numerous lytic metastases throughout the thoracolumbar spine and bilateral ribs. Pathologic compression fracture of T12 vertebral body.At several vertebral levels, there is significant tumor infiltration of the epidural space, such as at T5 (series 9, image 90); if there is clinical concern for cord involvement/compression, MRI would be useful.Borderline enlarged right axillary lymph nodes, suspicious for local metastases, including a 10 mm lymph node (series 9, image 74).UPPER ABDOMEN: Refer to separately dictated same-day CT abdomen/pelvis report. | 1. No evidence of pulmonary embolism.2. Right breast mass consistent with known breast cancer.3. Extensive osseous metastasis. At multiple vertebral levels, there is significant tumor infiltration into the epidural space and if clinical concern exists for cord compression/involvement, MRI w/wo contrast would be useful.4. Intrapulmonary lymph nodes bilaterally, unusual in their multiplicity; metastatic disease cannot be excluded and continued follow-up is recommended to assess stability.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Reason: characterization of neck swelling History: 1 day of neck swelling There is extensive subcutaneous soft tissue stranding and inflammatory change superficial to the right parotid gland with skin and fascial thickening, but no evidence of fluid collection/abscess. There is mild asymmetry of the right parotid gland relative to the left without intraparotid masses, stones, or ductal dilation. The submandibular glands appear unremarkable. There is nodularity of the right thyroid lobe.There is no significant lymphadenopathy. There are mild atherosclerotic calcifications of of carotid arteries. The visualized intracranial and orbital contents are unremarkable.Severe multilevel degenerative changes affect the cervical spine. There is centrilobular and paraseptal emphysema of the visualized lung apices. | 1. Asymmetric subcutaneous inflammatory changes overlying the right parotid gland with skin thickening raises suspicion for cellulitis. No discrete fluid collection or abscess. 2. Mild asymmetric enlargement of the right parotid gland may be reactive or inflammatory in etiology. No intraparotid masses, stone, or fluid collections are identified. 3. Other findings as described above. |
Generate impression based on findings. | There is a 9 x 6 mm hyperattenuating focus in the right frontal corona radiata on series 4 image 23 without significant surrounding edema and minimal mass-effect with slight indentation of the superior aspect of the anterior body of the right lateral ventricle. There is mild advanced diffuse volume loss with diffusely prominent which may be treatment related given the patient's underlying breast cancer. Additionally, the morphology of the cerebellar tonsils is somewhat bulky, rounded and somewhat masslike. However, there is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | 1.A 9 x 6 mm hyperattenuating focus in the right frontal corona radiata with minimal mass effect indenting the superior aspect of the right lateral ventricle may represent a hemorrhagic lesion. Differential diagnoses include small focal parenchymal hemorrhage, cavernoma, or infectious/inflammatory etiology (possibly even chronic) with focal area of mineralization, or possibly a hemorrhagic metastasis given history of breast cancer. Further evaluation with MRI without and with IV contrast is recommended.2.Bulky and rounded morphology of the cerebellar tonsils demonstrate etiology. This can also be further evaluated on follow-up MRI.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | There is no acute intracranial hemorrhage, mass effect, or midline shift. The ventricles, sulci, and cisterns are normal in size and configuration with preserved gray-white differentiation. The calvarium is unremarkable without fracture. The imaged portions of the orbits, paranasal sinuses, and mastoid air cells are unremarkable. | No acute intracranial abnormalities. |
Generate impression based on findings. | There is advanced global parenchymal volume loss with associated ex vacuo dilatation of the ventricular system appearing similar to the recent prior study. Periventricular hypoattenuation consistent with advanced chronic small vessel ischemic disease with encephalomalacia involving the left frontal corona radiata is also unchanged. There is no acute intracranial hemorrhage, mass-effect, or midline shift. There is mild paranasal sinus opacification. An NG tube is in place. The calvarium appears intact. | 1.No acute intracranial hemorrhage or mass-effect. Please note that CT is insensitive for the detection of acute ischemia, and MRI should be considered if there is continued clinical suspicion.2.Advanced small vessel ischemic disease and global parenchymal volume loss without acute interval change since the prior study. |
Generate impression based on findings. | Male 3 days old Reason: evaluate for atelectasis or other intrapulmonary process History: increased resp acidosisVIEW: Chest AP (one view) 2/14/15 at 844 hours. Umbilical lines and NG tube unchanged. ET tube tip is at the carina or right mainstem bronchus. Cardiac silhouette size is normal. Persistent right upper lobe atelectasis on a background of surfactant deficiency pattern. | ET tube terminates at the carina or right mainstem bronchus.Persistent right upper lobe atelectasis on a background of diffuse lung surfactant deficiency disease. |
Generate impression based on findings. | There is a stable 9 x 6 mm hyperattenuating focus in the right frontal corona radiata without significant change. There is mild advanced diffuse volume loss with diffusely prominent which may be treatment related given the patient's underlying breast cancer. Additionally, the morphology of the cerebellar tonsils are mildly bulky, rounded and somewhat masslike but unchanged from prior exam. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | 1.Stable 9 x 6 mm hyperattenuating focus in the right frontal corona radiata. Differential diagnoses remain similar to those discussed on the earlier exam. Further evaluation with MRI without and with IV contrast is recommended.2.Stable bulky morphology of the cerebellar tonsils.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Female, 37 years old, with headache and altered mental status status post subarachnoid hemorrhage. Subarachnoid hemorrhage is redemonstrated predominately within the posterior fossa, particularly around the cervicomedullary junction but extending superiorly along the pons to the level of the interpeduncular and quadrigeminal plate cisterns. Since the prior examination blood product has further redistributed into the ventricular system with layering blood now more evident in the occipital horns. Blood product has also migrated into the right Sylvian fissure as well as several of the cerebral sulci bilaterally. Since the prior examination a right frontal approach ventricular catheter has been placed. The tip of this catheter sits at the right foramen of Monro. The ventricles remain mildly enlarged similar to what was seen on prior exams.Patchy hypoattenuation involving the frontal lobes, left side more than right, as well as the left opercular regions. The left lateral ventricle shows evidence of ex vacuo dilatation. | Redemonstration of extensive subarachnoid blood predominately in the posterior fossa but with extension to the supratentorial brain and in the intraventricular space. Although blood product has redistributed, overall there does not seem to be an increased quantity of blood.Since the prior examination, a right frontal ventriculostomy catheter has been placed. The ventricles remain enlarged similar to prior.Redemonstration of multiple areas of parenchymal hypoattenuation favored to represent encephalomalacia. |
Generate impression based on findings. | There is no acute intracranial hemorrhage, mass effect, or midline shift. The ventricles, sulci, and cisterns are normal in size and configuration with preserved gray-white differentiation. The calvarium is unremarkable without fracture. There is partial opacification of the right maxillary sinus. | No acute intracranial hemorrhage or mass effect. No specific evidence of intracranial malignancy or metastasis within the limitations of a noncontrast study. If there is continued clinical suspicion, contrast enhanced MRI or CT may be considered. |
Generate impression based on findings. | There is no acute intracranial hemorrhage, mass effect, or midline shift. There are low attenuation foci within the cerebral hemispheres, basal ganglia, and brainstem which is nonspecific but most likely represents age indeterminate small vessel ischemic disease. The ventricles, sulci, and cisterns are normal in size and configuration with preserved gray-white differentiation. The calvarium is unremarkable without fracture. The imaged portions of the orbits, paranasal sinuses, and mastoid air cells are unremarkable. | 1. No acute intracranial hemorrhage or mass effect. 2. Low attenuation foci within the cerebral hemispheres, basal ganglia, and brainstem are nonspecific but most likely represent age indeterminate small vessel ischemic disease. Note that CT is insensitive for the detection of acute ischemia, and MRI should be considered if there is continued clinical suspicion. |
Generate impression based on findings. | There is a new parenchymal hematoma measuring 17 x 8 mm in the posterior aspect of the pons on series 1 image 11/sagittal image 32 with surrounding surrounding vasogenic edema and partial effacement of the fourth ventricle. The hematoma is new, edema within the brainstem was present on prior exams. Generalized intracranial mass effect is redemonstrated with effacement of the basilar cisterns and persistent bilateral uncal and tentorial herniation with severe mass effect in the posterior fossa and the brainstem which is grossly unchanged from 2/13/2015 but worsened from 2/11/2015. There is redemonstration of approximately 49 x 39 mm left thalamic hematoma with adjacent vasogenic edema without significant change in size. There are unchanged patchy areas of focal cytotoxic edema extending to the left posterior frontal and parietal lobes, as well as the left temporal lobe consistent with areas of infarction better depicted on 2/7/2015 MRI, compatible with areas of evolving recent infarction. There is unchanged right transfrontal ventricular catheter terminating in the atrium of the right lateral ventricle with decreased size of the right lateral ventricle and mildly increased midline shift to the right of 18 mm compared to 14 mm previously. | 1. New acute parenchymal hematoma in the posterior aspect of pons with surrounding edema, mass effect and partial effacement of the fourth ventricle, likely representing a Duret hemorrhage.2. Stable large left thalamic hematoma with surrounding vasogenic edema and mass effect.3. Scattered areas of evolving recent infarction in the left cerebral hemisphere as described above, better depicted on earlier MRI.4. Decreased size of right lateral ventricle with worsened midline shift to the right, which may be secondary to increased ventricular shunting.5. Intracranial mass effect otherwise is without significant change with subfalcine, uncal and transtentorial herniation as noted above.The finding regarding brain stem hemorrhage has been described to neurology resident Dr. Flangini over the telephone at 9:42 a.m. today.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | There is mild prominence of the lateral and to a lesser extent the third ventricle for age. There is no acute intracranial hemorrhage, mass effect, or midline shift. The fourth ventricle, sulci, and cisterns are normal in size and configuration with preserved gray-white differentiation. The calvarium is unremarkable without fracture. Note is made of an empty sella. The imaged portions of the orbits, paranasal sinuses, and mastoid air cells are unremarkable. | 1. Mild ventricular prominence and empty sella could possibly represent sequela of pseudotumor cerebri, the current clinical significance of which is uncertain without comparison studies. Prior studies may be submitted for comparison if clinically warranted. 2. No evidence of acute edema, mass effect, or hemorrhage. |
Generate impression based on findings. | Pain with movement. There is no fracture or malalignment at the glenohumeral joint. The acromioclavicular joint remains articulated, however, comparison with the contralateral shoulder for a normal variant appearance may be considered if this is the site of the patient's pain. No significant abnormality is otherwise evident. | Comparison with the contralateral shoulder for a normal variant appearance of the acromioclavicular joint may be considered if this is the site of the patient's pain. Otherwise, no fracture or malalignment is evident. |
Generate impression based on findings. | There is mild global parenchymal volume loss with ex vacuo ventricular dilation and periventricular hypoattenuation consistent with small vessel ischemic disease, without acute interval change since the prior study. There is no acute intracranial hemorrhage, mass-effect, or midline shift. There is extensive opacification of the paranasal sinuses containing hyperattenuating material, with increased right maxillary and left sphenoidal, and left frontal sinus opacification since the prior study. | 1. No acute intracranial hemorrhage or mass effect. 2. Increased extensive sinus opacification since the prior study containing areas of high attenuation which may represent inspissated secretions versus fungal sinusitis. |
Generate impression based on findings. | Female, 27 years old, with headache status post arachnoid hemorrhage. Findings are seen compatible with right pterional craniotomy and placement of an aneurysm clip in the right paraclinoid region. A right frontal approach ventriculostomy catheter is in place, tip in stable position within the left lateral ventricle. The ventricles are decompressed and stable in size.Minimal intraventricular blood product is redemonstrated similar to prior. No large intracranial collections are seen. As before, areas of hypoattenuation are evident affecting the right anterior temporal lobe, the bilateral gyri recti and the right caudate region, and the left anterior paramedian frontal lobe. | 1.Redemonstration of findings related to craniotomy and aneurysm clip placement on the right.2.A right frontal approach ventriculostomy catheter is in stable position. The ventricles remain decompressed. A small amount of intraventricular blood product is demonstrated.3.Hypoattenuation affecting the right temporal lobe, the bilateral frontal lobes and right caudate is seen, not significantly changed in geographic extent. Findings may reflect ischemic injury. |
Generate impression based on findings. | Multiple areas of supratentorial and infratentorial high attenuation are consistent with multifocal acute parenchymal hemorrhages. The largest focus of hemorrhage in the right temporal-occipital region measures 2.7 x 2.2 cm in axial dimension (series 5 image 16). Other areas of acute hemorrhage are also present in the right temporal lobe, right medial parietal lobe, left temporal occipital region, and the right cerebellum. There is vasogenic edema surrounding these lesions which results in significant mass effect with marked effacement of the prepontine cistern and crowding in the posterior fossa. There is marked effacement of the fourth ventricle with mild prominence of the third ventricle and asymmetric prominence of the left lateral ventricle. The orbits, paranasal sinuses, and calvarium appear unremarkable. | Multifocal intraparenchymal cerebral and cerebellar hemorrhage as described above with extensive edema and mass effect particularly in the posterior fossa. These findings were discussed with the physician at pager 9100 on 2/14/15 at 1925 by the radiology resident on call. |
Generate impression based on findings. | Feeding tube placement Distal end of feeding tube within stomach. No bowel obstruction. | Distal end of feeding tube within stomach. No bowel obstruction |
Generate impression based on findings. | NG tube placement Distal end of NG tube at GE junction with distal side port within the distal esophagus. Dilated small bowel loops unchanged. | Distal end of NG tube at GE junction with distal side port within the distal esophagus. Small bowel obstruction again noted. |
Generate impression based on findings. | Weakness epigastric abdominal pain Abnormally dilated proximal small bowel loops out of proportion with respect to the distal small bowel. | Abnormally dilated proximal small bowel loops out of proportion with respect to the distal small bowel consistent with partial small bowel obstruction. |
Generate impression based on findings. | Femoral line placement Distal end of left femoral line projects over midline sacrum. No bowel obstruction | Distal end of left femoral line projects over midline sacrum. No bowel obstruction |
Generate impression based on findings. | Abdominal pain Mildly dilated left upper quadrant small bowel loops. No free air. | Mildly dilated left upper quadrant small bowel loops. Findings may represent early partial small bowel obstruction versus localized ileus. No free air. |
Generate impression based on findings. | Chronic obstruction and decreased stool output No bowel obstruction | No bowel obstruction |
Generate impression based on findings. | HEAD: There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation.MAXILLOFACIAL: There is a mildly displaced left orbital floor fracture with herniation of left intraorbital fat through the defect. There is no evidence of extraocular muscle entrapment or herniation through the fracture site. There is moderate hemorrhagic air-fluid level in left maxillary sinus with superimposed mild mucosal thickening. There is mild left preseptal and pre-maxillary soft tissue swelling. There is no retrobulbar are infiltration. The globes are intact. The remaining paranasal sinuses are clear. The imaged mastoid air cells are clear. The nasal bone, zygomas, pterygoid plates and lamina papyracea are intact.CERVICAL: There is no acute fracture, subluxation or prevertebral soft tissue swelling. There is mild soft tissue air tracking along the left aspect of the esophagus from the level of the thyroid cartilage, and the right aspect of the trachea below the level of the thyroid gland. The entire extent of pneumocephalus is not fully imaged on this cervical spine examination. | 1.Mildly displaced left orbital floor fracture with herniation of intraorbital fat. No retrobulbar hematoma. No evidence of extraocular muscle entrapment or herniation. Recommend correlation with clinical exam.2.Mild foci of soft tissue gas tracking along the left aspect of the esophagus in the right aspect of the trachea, incompletely imaged. The etiology of this finding remains indeterminate on the basis of this exam and further investigated if clinically warranted.3.No evidence of acute traumatic injury to the head or cervical spine.Findings were discussed with emergency room Dr. Druelinger of the telephone at 10:04 a.m. today.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Abdominal pain No bowel obstruction. Extensive stool burden throughout the colon. | No bowel obstruction. Extensive stool burden throughout the colon. |
Generate impression based on findings. | High stool burden with abdominal pain Distal end of jejunal tube probably within the proximal jejunum. No bowel obstruction | Distal end of jejunal tube probably within the proximal jejunum. No bowel obstruction |
Generate impression based on findings. | Feeding tube placement Distal end of feeding tube within stomach. Mild ileus pattern | Distal end of feeding tube in stomach. Mild ileus pattern |
Generate impression based on findings. | Feeding tube placement Distal end of feeding tube within stomach. Mild ileus pattern | Distal end of feeding tube within stomach. Mild ileus pattern |
Generate impression based on findings. | Abdominal pain nausea vomiting Residual contrast within colon. Multiple dilated centrally located loops of small bowel | Multiple dilated centrally located loops of small bowel raises the possibility of partial small bowel obstruction. |
Generate impression based on findings. | There is mild periventricular hypoattenuation consistent with chronic small vessel ischemic disease. There is no acute intracranial hemorrhage, mass effect, or midline shift. The ventricles, sulci, and cisterns are normal in size and configuration with preserved gray-white differentiation. The calvarium is unremarkable without fracture. The imaged portions of the orbits, paranasal sinuses, and mastoid air cells are unremarkable. | 1. No acute intracranial hemorrhage or mass effect. 2. Mild chronic small vessel ischemic disease. |
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