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Generate impression based on findings. | Reason: s/p L lower lobectomy for squamous lung cancer in November 2014. surveillance for evidence of disease recurrence History: dementia; interstitial pneumonitis CHEST:LUNGS AND PLEURA: Interval resection of previously noted left lower lobe cavitating mass.Mild residual pleural and parenchymal scarring is noted.Severe upper lobe predominant centrilobular paraseptal emphysema.Basilar subpleural microcystic changes and septal thickening consistent with interstitial fibrosis similar in appearance to prior exam.No pleural effusions.No new suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Stable scattered mildly prominent mediastinal and hilar nodes without definite evidence of lymphadenopathy.Cardiac size is normal without evidence for pericardial effusion.Severe coronary artery calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable left hepatic lobe hypodensity compatible with a cyst.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Stable aneurysmal dilatation of the infrarenal abdominal aortaBOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Marked degenerative changes and changes of degenerative disk disease within the lumbar spine.OTHER: No significant abnormality noted. | Interval left lower lobectomy for squamous cell lung cancer without evidence of recurrent or metastatic disease. |
Generate impression based on findings. | Left proximal humerus fracture. Preoperative planning. There is a comminuted fracture through the surgical neck of the left humerus with anteromedial displacement and posterior angulation of the distal fracture fragment. The humeral head is fragmented at the greater tubercle. The humeral head remains articulated with the scapular glenoid. The humerus distal to the fracture is otherwise unremarkable. The acromioclavicular joint is intact. No additional fractures are visualized on this exam. | Comminuted fracture through the surgical neck of the left humerus, as above. |
Generate impression based on findings. | Bronchiolitis follow-upVIEWS: Chest AP/lateral (two views) 2/16/2015 0457 Right upper lobe atelectasis is present. Hyperexpansion of the lungs is compatible with given diagnosis of bronchiolitis. No pleural effusion or pneumothorax is present.The cardiothymic silhouette is normal. | Hyperexpansion of the lungs is compatible with given diagnosis of bronchiolitis. Right upper lobe atelectasis. |
Generate impression based on findings. | FeverVIEW: Chest AP 2/15/15 Tracheostomy tube in place. Right central line and left PICC again noted. Cardiothymic silhouette normal. Left lower lobe atelectasis improved in the interval. No pleural effusion or pneumothorax. | Left lower lobe atelectasis improved in the interval. |
Generate impression based on findings. | 12 year old female with hemoptysis. Rule out TB, pulmonary infection, cardiomyopathyVIEWS: Chest PA/lateral (two views) 2/15/2015 Cardiac silhouette is normal. Minimal subsegmental atelectasis in the right lower lobe. No focal pulmonary opacities. No pleural effusion or pneumothorax. | Minimal atelectasis with no evidence of pneumonia. |
Generate impression based on findings. | Intubated, on oscillatorVIEW: Chest AP (one view) 2/16/2015 0424 UAC tip is at T6-T7. Endotracheal tube tip is below the thoracic inlet and above the carina. Nasogastric tube extends to the stomach with its sidehole at the GE junction.Large lung volumes with diffuse hazy pulmonary opacities are unchanged. No pleural effusion or pneumothorax. The cardiothymic silhouette is within normal limits. | No change in diffuse lung opacities. |
Generate impression based on findings. | PICC placementVIEW: Chest AP 2/15/15 NG tube tip in the stomach. Endotracheal tube has been removed in the interval. Left upper extremity PICC coiled in the SVC. Cardiothymic silhouette at the upper limits of normal. Left lower lobe atelectasis new from prior study. No pleural effusion or pneumothorax. Metallic hardware at the mandible. | Left PICC tip coiled within the SVC. |
Generate impression based on findings. | Ms. Bernt is a 68 year old female with a personal history of left breast lumpectomy in December 2006 for ILC followed by radiation therapy. Personal history of benign right breast biopsy for intraductal papilloma in 2013. She has no current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the left breast. There are stable postsurgical changes including architectural distortion, increased density, and surgical clips present within the left lumpectomy site. Percutaneously placed wing clip present within the right inferior breast, at site of prior benign biopsy. Scattered benign calcifications are present bilaterally. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | Stable postsurgical changes of the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Reason: is there cancer? History: smoking, weight loss, ?mass on xray LUNGS AND PLEURA: Patchy multifocal airspace and interstitial opacities, worst in the left lower lobe. Mild pulmonary edema. Bilateral pleural effusions, left greater than right.MEDIASTINUM AND HILA: Cardiomegaly. Moderate coronary calcification. Atherosclerotic calcification of the aorta and its branches. Calcified nodes consistent with healed granulomatous disease. Calcified thyroid nodules only partially visualized. Trace pericardial fluid.CHEST WALL: Degenerative change involving the spine. Healed rib fracture on the right. Densely sclerotic focus in anterior T3 vertebral body appears to be related to a hemangioma though is incompletely evaluated.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Cholelithiasis, partially visualized. | Cardiomegaly with multifocal airspace interstitial opacities, pulmonary edema and pleural effusions suggestive of CHF. Superimposed aspirate or infection cannot be excluded. Given the patient's age and history the findings should be followed to resolution as an underlying neoplasm could be obscured. |
Generate impression based on findings. | Male 35 years old Reason: SBO? History: abdominal pain Exam is limited by lack of oral contrast.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Mild periportal edema with increased ascites compared to prior exam. No focal liver lesions. No biliary dilatation. Cholelithiasis without acute inflammation.SPLEEN: Splenic granulomata, unchanged.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small kidney size consistent with known medical renal disease. Several hypodensities in both kidneys are too small to characterize and likely represent cysts, unchanged. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Jejunum is dilated measuring up to 4.7 cm in the left upper quadrant (series 3, image 79) with decompression of the distal small bowel consistent with a small bowel obstruction. A transition point is not well visualized and is likely present in the mid pelvis.No pneumatosis or intraperitoneal free air.New nonspecific wall thickening in the ascending colon at the level of the hepatic flexure.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Increased pelvic ascites. | 1.Findings consistent with a distal small bowel obstruction with a transition point in the midline pelvis.2.Increased ascites.Findings were discussed with the emergency medicine resident, Dr. Chali, at 9:15 a.m. on 2/16/2015. |
Generate impression based on findings. | IntubatedVIEW: Chest AP 2/16/15 ET tube tip below thoracic inlet and above the carina. There are two NG tubes in the stomach. Right central line in place. Cardiothymic silhouette at the upper limits of normal. Minimal left lower lobe atelectasis unchanged. No pleural effusion or pneumothorax. | Minimal left lower lobe atelectasis unchanged. |
Generate impression based on findings. | Hypoxia intubatedVIEW: Chest AP 2/15/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Umbilical lines unchanged. Cardiothymic silhouette normal. Diffuse lung haziness with right upper lobe atelectasis unchanged. No pleural effusion or pneumothorax. | Diffuse lung haziness with right upper lobe atelectasis unchanged. |
Generate impression based on findings. | Female 76 years old Reason: r/o fx History: pain. There is severe joint space narrowing of the medial tibiofemoral compartment. There are tricompartmental osteophytes. There is a small suprapatellar joint effusion. No acute fracture or dislocation. | Severe osteoarthritis of the left knee without definite fracture or dislocation. |
Generate impression based on findings. | Female 76 years old Reason: r/o fx History: fall, pain. There is no fracture or dislocation. There is multilevel periosteal hypertrophy of the mid thoracic vertebral spine compatible with DISH. | No fracture or dislocation. DISH of the mid-thoracic vertebral bodies. |
Generate impression based on findings. | Female 76 years old Reason: r/o fx History: pain. Widening of scapholunate interval suggestive of scapholunate dissociation. There is no acute fracture or dislocation. There is increased sclerosis around both radiocarpal joint as well as the radial/ulnar joint compatible with degenerative arthritic changes. | No acute fracture or dislocation. Widening of the scapholunate interval suggestive of scapholunate dissociation. Osteoarthritis of the wrist joint as described above. |
Generate impression based on findings. | NECK: There are unchanged posttreatment findings including partial right parotidectomy, associated skin thickening and subcutaneous fat stranding as well as right neck dissection. There is no evidence of recurrent mass lesions or significant cervical lymphadenopathy. However, there are subcentimeter scattered enhancing nodules in the suboccipital soft tissues which are slightly enlarged compared to the prior exam though they remain nonspecific and may be reactive; these should be reevaluated on follow-up. There is a 9-mm stable calcification the left parotid gland without associated ductal dilatation. Again noted is partial right parotid and complete right submandibular gland resection. The thyroid and major salivary glands are otherwise unremarkable. There are atherosclerotic calcifications of the carotid bifurcations. The major cervical vessels are otherwise patent. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear.HEAD: There is no suspicious intracranial enhancement, mass effect, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | 1.Posttreatment findings without evidence of locoregional tumor recurrence or significant cervical lymphadenopathy.2.A few slightly larger enhancing suboccipital subcentimeter soft tissue nodules are nonspecific and may be reactive. Attention is recommended at follow up.3.No evidence of intracranial metastases. |
Generate impression based on findings. | L proximal humerus fracture. LEFT SHOULDER/HUMERUS: There is a comminuted fracture through the surgical neck of the left humerus with anteromedial displacement and posterior angulation of the distal fracture fragment. The humeral head remains articulated with the scapular glenoid. The humerus distal to this fracture is unremarkable. The AC joint is intact. C-SPINE: The lower cervical spine including C6 and C7 is obscured by overlying soft tissues. Status post surgical fusion of C1-C2, with decreased posterior angulation of the odontoid process. No radiographic evidence of hardware complication. Fusion of C5 and C6 with scattered degenerative changes are again noted. | 1. Comminuted left humerus fracture, as above.2. Post-surgical changes of the cervical spine. |
Generate impression based on findings. | Female 76 years old Reason: r/o fx History: pain. Again seen is widening of the scapholunate interval suggestive of scapholunate dissociation. There is no acute fracture or dislocation. Degenerative arthritic changes affect the distal interphalangeal joints. | Scapholunate interval widening chest scapholunate dissociation. No acute fracture or dislocation. Osteoarthritis of the distal interphalangeal joints. |
Generate impression based on findings. | Male 54 years old Reason: fx History: pain. No acute fracture or dislocation. No soft tissue swelling seen. Minimal degenerative changes affect the glenohumeral joint. | No acute fracture or dislocation. |
Generate impression based on findings. | Female 62 years old Reason: r/o fracture History: deformity. Three views of the left ankle show soft tissue swelling surrounding the joint with the fat planes surrounding the Achilles' tendon appear abnormal. There appears to be fusiform swelling of the Achilles' tendon. It is unclear if this is a chronic or acute deformity. There is no underlying fracture or dislocation. | Nonspecific fusiform swelling of the Achilles' tendon may reflect an acute or chronic deformity. No acute fracture or dislocation.These findings were verbally relayed to Dr. Roslyn Chi at 0905 on 2/16/2015 |
Generate impression based on findings. | Reason: acute RUL opacity on CXR, positive Ur Strep pneumo Ag on chronic severe COPD History: cough productive of brown sputum LUNGS AND PLEURA: Patchy multifocal airspace and interstitial study in the right upper and lower lobes suggestive of pneumonia or aspirate. No significant pleural effusion. Very faint patchy subpleural nonspecific opacities on the left. Emphysema.MEDIASTINUM AND HILA: No significant cordate calcification on this non-gated study. Scattered borderline roughly 1 cm mediastinal nodes.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Splenules as on prior. | Patchy multifocal airspace and interstitial study in the right upper and lower lobes suggestive of pneumonia or aspirate. |
Generate impression based on findings. | Reason: Hx of DVT r/o PE History: Tachycardia/Chest pain PULMONARY ARTERIES: Exam is somewhat limited and suboptimal contrast opacification of the pulmonary arterial system. No evidence pulmonary embolism to the lobar level. The main pulmonary artery measures up to 32 mm, suggestive of pulmonary hypertension.LUNGS AND PLEURA: Mild basilar subsegmental atelectasis/scarring. Mild centrilobular emphysema predominantly affects the upper lobes. Nonspecific peripheral reticulation/scarring is seen in the anterior upper lobes and posterior lower lobes.No focal air space consolidations. No pleural effusions.No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: The heart is upper normal in size, without pericardial effusion. Severe coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Punctate foci of pneumoperitoneum. Please see abdomen pelvis report for further details. | 1. No evidence of pulmonary embolism to the lobar level. Mild centrilobular emphysema predominantly affects the upper lobes. Nonspecific peripheral reticulation/scarring is seen in the anterior upper lobes and posterior lower lobes. Findings are similar to 7/14/2014.2. Contrast extravasation as detailed above.3. Punctate foci of pneumoperitoneum. Please see abdomen pelvis report for further details. Findings communicated to Dr. Patel by Dr. Mehta at the time of exam.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Abdominal pain. Asses CBD dilation on CT. LIVER: No significant abnormalities noted.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. The common bile duct measures 1.1 cm in diameter which is unchanged and nonspecific.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted. | Stable nonspecific common bile duct dilatation. |
Generate impression based on findings. | Ms. Young is a 55 year old female with a personal history of left breast mastectomy in 2009 for ILC followed by radiation and chemotherapy. Personal history of right mastopexy in 2010. She currently complains of intermittent right breast pain for the past 5 months. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Postsurgical changes from prior breast mastopexy are present. Scattered benign calcifications are identified. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Reason: lung cancer History: lung cancer CHEST:LUNGS AND PLEURA: 4-mm nodule peripherally in the right upper lobe (image 83 series 5) presumably representing this patient's known lung cancer. This appears similar to the prior outside PET/CT dated 8/19/14.Scattered benign appearing micronodules without additional suspicious pulmonary nodules or masses can be identified.Marked upper lobe predominant centrilobular emphysema.No pleural effusions.MEDIASTINUM AND HILA: Left chest Port-A-Cath with its tip in the SVC.Prominent AP window lymph node measuring 11 mm in short axis (image 40 series 3). Cardiac size is normal without evidence of a pericardial effusion.Moderate coronary artery calcification.CHEST WALL: No axillary lymphadenopathy.Degenerative changes in the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative changes and degenerative disease in the lumbar spine.OTHER: Atherosclerotic changes of the abdominal aortic and iliac arteries. | 1.Small 4-mm somewhat spiculated nodule in the right upper lobe presumably representing this patient's known lung cancer. No significant interval change identified in comparison to a prior outside PET/CT. However, accurate comparison cannot be made to differences in technique and resolution. Recommend comparison to any prior dedicated chest CT exams if possible.2.Prominent AP window lymph node.3.Severe upper lobe predominant centrilobular emphysema. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are digital mammographic images of both breasts (2/10/15) and ultrasound images of both breasts (2/10/15) performed at Adventist Hinsdale Hospital. For comparison, digital mammographic images (8/14/08, 8/21/08) are available. DIGITAL MAMMOGRAPHIC IMAGES OF BOTH BREASTS (2/10/15):The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. A triangular marker is placed at upper outer quadrant of right breast, indicating the area of palpable concern. Ill-defined focal asymmetry, measuring approximately 5 cm, is present at the site of palpable concern in the right breast. There are pleomorphic calcifications at the site of this focal asymmetry, and they are extending posterior and inferomedially. Overall size of the area of pleomorphic calcifications in the right breast is 62 x 55 mm (AP x LR) on CC view, and 73 x 75 mm (AP x CC) on ML view.There are scattered benign appearing calcifications in the left breast. No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. ULTRASOUND IMAGES OF BOTH BREASTS (2/10/15):An ill-defined mass measuring 34 x 22 x 27 mm is present at 10:30 position, 4 cm from nipple, in the right breast, with internal echogenic foci consistent with calcifications. In addition, there is another ill-defined mass measuring 20 x 25 x 13 mm at 10:30 position, 6 cm from nipple, in the right breast. These two masses might be connected each other, and corresponding to the ill-defined asymmetry at upper outer quadrant on mammograms.At right 7:30 position, 3 cm from nipple, there is a lobulated, oval mass with parallel orientation, measuring 13 x 14 x 5 mm, likely benign fibroadenoma.There are multiple simple and complicated cysts in the right breast.Benign appearing lymph nodes are visualized in the right axilla.In the left breast, multiple simple and complicated cysts are present.Normal appearing lymph node is visualized in the left axilla. | 1. Suspicious mass at 10:30 position with extensive suspicious calcifications at upper outer - upper inner quadrants in the right breast. Benign appearing mass at 7:30 position in the right breast. 2. No mammographic or sonographic evidence for malignancy in the left breast.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | 16-day-old male with vomiting. Evaluate for obstruction.VIEWS: Abdomen AP and left lateral decubitus (two views) 2/15/2015 Diffusely dilated bowel loops, more prominent in the left abdomen, with a disorganized bowel gas pattern. Air is seen distally in the rectum. No pneumoperitoneum, pneumatosis intestinalis, portal venous gas or ascites. No evidence of hernia is seen. No focal pulmonary opacities in the visualized lung bases. | Diffusely dilated bowel loops with no definite evidence of obstruction. |
Generate impression based on findings. | Reason: anatomic evaluation History: trach dependent,mmultiple prior surgeries LUNGS AND PLEURA: S/P right pneumonectomy with large pleural cutaneous defect. Packing material and a small amount of fluid in the right chest cavity. Large 1-2 cm open communication between the right bronchial stump and the right hemithorax. Air also extends anteriorly around the posterior aspect of the aortic root. Packing material is seen in the right bronchial stump.Left pleural effusion with multifocal airspace opacity on the left suggestive of pneumonia or aspirate. Post op change left apex.MEDIASTINUM AND HILA: Right PICC tip in SVC. Bronchopleural fistula and air collections within the mediastinum as described above. Mild coronary calcification. Status post tracheostomy with tip 4-5 cm above the carina.CHEST WALL: Extensive post op change on the right with multiple rib resections and open pleurocutaneous defect. Status post median sternotomy. Compression deformity of T3.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | S/P right pneumonectomy with large pleural cutaneous defect. Packing material and a small amount of fluid in the right chest cavity. Large 1-2 cm open communication between the right bronchial stump and the right hemithorax. Air also extends anteriorly around the posterior aspect of the aortic root. Packing material is seen in the right bronchial stump.Left pleural effusion with multifocal airspace opacity on the left suggestive of pneumonia or aspirate. |
Generate impression based on findings. | RUQ pain after eating. LIVER: The liver has increased echogenicity indicating hepatic steatosis. Again seen are multiple cystic lesions within the liver. The largest reference cyst in the right lobe is minimally complex and measures 9.6 x 6.4 cm.GALLBLADDER, BILIARY TRACT: The gallbladder is not well visualized. However there is a echogenic structure with prominent posterior shadowing in the region of the porta hepatis indicating probable wall echo shadow complex from gallstones. The wall thickness of the gallbladder is normal. The common bile duct measures 5 mm which is within normal limits.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: No significant abnormalities noted.OTHER: No significant abnormalities noted. | 1.Wall echo shadow complex indicating biliary stones. No evidence of cholecystitis.2.Hepatic steatosis.3.Multiple cystic liver lesions. The largest lesion in the right lobe which measures 9.6 x 6.4 cm is minimally complex and is of unknown etiology. |
Generate impression based on findings. | 42 years, Female. Reason: constipation History: abdominal pain, nausea Lung bases clear. Right femoral venous catheter in situ. Nonobstructive bowel gas pattern. Average burden liquid stool. | Nonobstructive bowel gas pattern. Average burden liquid stool. |
Generate impression based on findings. | 24 years, Male. Reason: verify position of NG, assess whether bowel gas pattern is consistent with SBO History: end ileostomy, nausea and vomitting Enteric feeding tube tip projects over the gastric body. Note that the pelvis is excluded from the field of view. Nonspecific dilated loops of jejunum in the midabdomen, less severely distended than on prior CT. The colon is collapsed. | Enteric feeding tube tip projects over the gastric body. |
Generate impression based on findings. | 68 years, Male. Reason: 68M s/p esophagectomy, on tube feeds, r/o ileus History: r/o ileus Left lower lobe pulmonary opacities may represent atelectasis and are better evaluated on chest radiograph 02/16/15. Surgical staples projected over the right paracentral abdomen. Surgical clips in the right and left upper quadrants. Lines and catheters in expected locationsGeneralized paucity of bowel gas which limits evaluation. Allowing for this there is no definite evidence of ileus. | Generalized paucity of gas throughout the abdomen limits evaluation. Allowing for this there is no definite evidence of ileus. |
Generate impression based on findings. | All of the paranasal sinuses are clear as are the bilateral mastoid air cells and middle ear cavities and there are no air-fluid levels. The bilateral maxillary sinus ostia are patent as are the bilateral frontoethmoidal and sphenoethmoidal recesses. Note is made of the tiny left and small right Haller cell. The lamina papyracea are intact bilaterally. The floor of the anterior cranial fossa and cribriform plate region are unremarkable. The nasal septum is deviated rightward with a right-sided septal spur. Bilateral orbits and the posterior nasopharynx appear unremarkable. | The nasal septum is deviated rightward with a right-sided septal spur. |
Generate impression based on findings. | There are unchanged posttreatment findings related to left partial glossectomy and left neck dissection without evidence of recurrent tumor or significant cervical lymphadenopathy. The left submandibular gland is surgically absent. The remaining salivary glands are within normal limits. There is an unchanged heterogeneous exophytic thyroid nodule extending inferiorly from the isthmus that measures up to 13 mm. There is mild atherosclerotic plaque of the carotid bifurcations. The major cervical vessels are otherwise patent. There is a stable ovoid soft tissue density at the confluence of the left internal jugular and subclavian veins which is unchanged from 1/12/2013. The airways are patent. There mild cervical degenerative changes. There is no osseous lesion identified. The imaged intracranial structures are within normal limits. There are small air-fluid levels in the bilateral maxillary sinuses and the left sphenoid sinus. There is mild ethmoid mucosal thickening. There is partial left mastoid opacification again seen. There is mild scarring in the bilateral lung apices. Please refer to accompanying dedicated CT chest for further details. | 1.Stable post treatment findings without locoregional tumor recurrence or significant cervical lymphadenopathy.2.Stable heterogeneous exophytic thyroid nodule extending inferiorly from the isthmus.3.Bilateral maxillary and left sphenoid sinus air-fluid levels suggesting acute sinusitis in the proper clinical setting. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | 69 years, Male. Reason: Dobhoff tube placement History: New Dobhoff after patient removed old one. Aspiration on Swallow study Enteric feeding tube tip projects over gastric body.Mildly dilated loops of bowel in the left hemiabdomen.Note that the pelvis is excluded from the field of view. | Enteric feeding tube tip projects over gastric body. |
Generate impression based on findings. | 66 years, Female. Reason: Assess NG tube placement History: AMS Note that the pelvis is excluded from the field of view. Enteric feeding tube tip projects over the gastric body. Nonspecific mildly dilated loops of small bowel may represent ileus. | Enteric feeding tube tip projects over the gastric body. |
Generate impression based on findings. | 60 years, Male. Reason: advanced dobhoff tube. pls comment on tip location History: as above Enteric feeding tube tip is advanced and projects over the gastric fundus. Note that the lower pelvis is excluded from the field of view. Nonobstructive bowel gas pattern. Vascular calcifications are again noted. | Enteric feeding tube tip is advanced and projects over the gastric fundus. |
Generate impression based on findings. | 60 years, Male. Reason: dobhoff position History: dobhoff replacde Note that the pelvis is excluded from the field of view. Enteric feeding tube tip projects over the distal esophagus. Nonobstructive bowel gas pattern. | Enteric feeding tube tip projects over the distal esophagus. |
Generate impression based on findings. | 63 years, Male. Reason: 63yo M with worsening epigastric pain, rule out air under diaphragm and obstruction. History: epigastric pain Changes of median sternotomy. Old epicardial leads in situ. Elevated left hemidiaphragm and left basilar opacities are unchanged. Nonobstructive bowel gas pattern. Average stool burden. No intramural or subdiaphragmatic free air. | Nonobstructive bowel gas pattern. No subdiaphragmatic free air. |
Generate impression based on findings. | 60 years, Male. Reason: dobhoff position History: possibly dislodged ngt Enteric feeding tube tip projects over the distal esophagus. Note that the pelvis is excluded from the field of view. Nonobstructive bowel gas pattern. | Enteric feeding tube tip projects over the distal esophagus. |
Generate impression based on findings. | Reason: assess extent of nasal polyposis and chronic sinusitis History: large nasal polyps seen on nasal endoscopy; h/o chronic nasal congestion and chronic sinusitis The ostiomeatal complex units are patent bilaterally. Within the nasal cavity there is a opacification of middle and superior nasal conchae.The frontal sinuses are near completely opacifiedMaxillary sinuses demonstrate mucosal thickening left more than right . There is a mucosal thickening at the os immunocomplex units left more than right with obliteration of the infundibulum of the left ostiomeatal complex unit.Ethmoid air cells are near completely opacified and associated with some hyperdense opacities.Sphenoid sinuses demonstrate mild mucosal thickening.Visualized portions of the mastoid air cells and middle ears are clear. Visualized orbits are intact and the visualized intracranial structures are within normal limits. | 1.There is opacification of ethmoid air cells and frontal sinuses associated with opacification of the nasal cavity which is suspicious for obstruction due to nasal polyposis with some inspissated secretions.2.Opacity at the left ostiomeatal complex unit may be related to an antrochoanal polyp. |
Generate impression based on findings. | Dyspnea, abnormal CT chest. The comparison chest radiograph performed on 2/16/2015 demonstrates no focal pulmonary opacities or pleural fluid. The ventilation images show a uniform distribution of activity on single-breath and wash-in images. There is no abnormal Xe-133 retention during the wash-out phase. The perfusion images show a physiologic distribution of pulmonary perfusion. | Normal ventilation and perfusion images. No evidence of pulmonary embolism. |
Generate impression based on findings. | 27 -year-old male with abdominal pain -- groin and flank pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No parenchymal renal mass lesions are seen. No urinary tract abnormal calcifications are seen. Increased right renal hydronephrosis and proximal hydroureter is seen. Long segment wall thickening of the proximal and mid right ureter is again visualized with enhancement, similar in extent to prior examination. This most likely represents inflammatory change, although less likely neoplasm cannot be excluded. The marked increase in hydronephrosis suggests progressive narrowing of the lumen. Due to the marked hydronephrosis, the excretory phase contrast pools in the kidney and does not delineate the right ureter lumen.Prompt excretion into normal left pyelo-calyceal system is seen within left ureter that is well opacified and appearing normal throughout its entire length to the bladder.No perinephric fluid collections are seen. Slight haziness about the right ureter in its mid course is again seen.RETROPERITONEUM, LYMPH NODES: Scattered small subcentimeter para-aortic lymph nodes are seen, unchanged. No enlarged lymph nodes meeting criteria for lymphadenopathy are seen. Retroperitoneum and vascular structures appear normal otherwise.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Long segment right ureter wall thickening and abnormal enhancement-- the extent appears unchanged since 3/25/14. These are findings most consistent with an inflammatory stricture, although malignancy cannot be excluded. 2. Increased marked right hydronephrosis most likely due to the ureteral stricture. No urinary tract calcifications seen. |
Generate impression based on findings. | 12 week old female with persistent pleural effusion on film.VIEW: Chest AP (one view) 2/16/2015 4:18 ET tube tip below the thoracic inlet and above the carina. Right central venous catheter tip terminates at the right atrium. Feeding tube tip coursing below the left hemidiaphragm extending beyond the inferior margin of the image. Diffuse bilateral pulmonary opacities increased from prior exam likely a combination of atelectasis and pleural effusion. No pneumothorax. Cardiothymic silhouette obscured by overlying pulmonary opacities. | Interval increase in diffuse bilateral pulmonary opacities likely a combination of atelectasis and pleural effusion. |
Generate impression based on findings. | 2-year-old male with AMS. Right IJ line placement.VIEW: Chest AP (one view) 2/16/2015 6:36 Right internal jugular venous catheter tip in the SVC. ET tube below the thoracic inlet and above the carina. Feeding tube tip in the stomach.Cardiothymic silhouette is normal. Right upper and left lower lobe atelectasis unchanged. No pleural effusion or pneumothorax. | Right IJ catheter tip in the SVC. |
Generate impression based on findings. | 61-year-old male with history of ALL. Evaluate for infection. There is near complete opacification of bilateral maxillary sinuses with surrounding thickening and sclerosis of the maxillary walls. This opacification extends into the nasal cavity on the left. Additionally, there are curvilinear high densities within the aforementioned opacities which likely represent inspissated secretions. There is evidence of prior bilateral maxillary antrostomies. The ostiomeatal complexes are opacified. There are no osseous erosions. There is mild mucosal thickening of the remaining paranasal sinuses. The lamina papyracea are intact. There is no evidence of orbital extension. The visualized intracranial structures are unremarkable. | Findings suggestive of chronic maxillary sinusitis with high density material likely representing inspissated secretions. It is possible that fungal infection may have a similar appearance. There is no associated osseous erosion appreciated. |
Generate impression based on findings. | Reason: Pt with extensive smoking history, we are looking for evidence of COPD vs. other insterstitial lung disease History: SOB, CHF LUNGS AND PLEURA: Small bilateral pleural effusions, right greater than left. Very mild pulmonary edema. Mild emphysema. Diffuse mild bronchial wall thickening. Subpleural ground glass interstitial opacity in the periphery of the right upper lobe, anteriorly (image 37/106) with mild volume loss. Scattered subpleural nodular opacities which are more likely due to scarring than solid nodules though continued follow-up is recommended. The largest is in the anterior left upper lobe (image 29/106) roughly 1 -- 2 cm in size. No significant air trapping on expiratory phase imaging.MEDIASTINUM AND HILA: Cardiomegaly. Severe coronary calcification. Small pericardial effusion. Scattered small subcentimeter lymph nodes. Minimal aspirated debris in central airways.CHEST WALL: Extensive degenerative change versus posttraumatic deformity involving the right upper sternum.Well-circumscribed near water density mass in left chest wall just below the nipple is presumably a cyst.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Small bilateral pleural effusions, right greater than left. Very mild pulmonary edema. Cardiomegaly.2. Mild emphysema. Diffuse mild bronchial wall thickening. 3. Subpleural ground glass interstitial opacity in the periphery of the right upper lobe, anteriorly with mild volume loss. Findings are most likely due to prior infection and scarring though organizing pneumonia can have this appearance in a chronic. More acutely this could be related to aspirate or infection.4. Scattered subpleural nodular opacities which are more likely due to scarring than solid nodules though continued follow-up is recommended to exclude growth/malignancy. The largest is in the anterior left upper lobe roughly 1 -- 2 cm in size. Follow up CT in 3-6 months is recommended if the patient has not had a prior outside CT for comparison. 5. Other findings as above. |
Generate impression based on findings. | Ms. Araujo is a 38 year old female with a personal history of right breast lumpectomy in June 2013 for triple negative IDC followed by radiation and neoadjuvant chemotherapy. History of benign biopsy of right breast in 03/14. She has no current breast related complaints. Three standard views of both breasts and two spot magnification views of the right breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Architectural distortion and increased density in the right upper, outer quadrant with multiple surgical clips, compatible with postsurgical changes from partial mastectomy. Skin thickening of the right breast compatible with prior radiation. Additional surgical clips in the right axillary region noted. A ribbon shaped clip from recent benign biopsy is present at right axillary tail.There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. In view of history of breast cancer in young age and patient's dense breasts, breast MRI might be useful for follow up modality in addition to the mammogram. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. Scattered benign calcifications are present bilaterally. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 2-year-old male with altered mental status, rule out obstruction.VIEW: Abdomen AP (one view) 2/16/2015 5:44 Feeding tube tip in the stomach.Average stool burden. Nonobstructive bowel gas pattern. Bladder is distended. | Normal examination. |
Generate impression based on findings. | History of thyroid cancer status post thyroidectomy. Rule out recurrent papillary thyroid cancer. RIGHT LOBE MEASUREMENTS: Surgically removedLEFT LOBE MEASUREMENTS: Surgically removedISTHMUS MEASUREMENTS: Surgically removedRIGHT LOBE: Surgically removed. No suspicious lesions in the thyroid bed. LEFT LOBE: Surgically removed. The tiny nonspecific hypoechoic, round structure in the left thyroid bed is unchanged.ISTHMUS: No significant abnormality noted.LYMPH NODES: Two benign appearing lymph nodes are identified. A right level II lymph node measures 1.0 x 1.0 x 0.4 cm which previously measured 1.6 x 1.1 x 0.5 cm. A left level II lymph node with a fatty hilum measures 0.4 x 0.5 x 0.2 cm, previously measured 1.4 x 1.1 x 0.4 cm. | Subcentimeter hypoechoic structure in the left thyroid bed that appears stable from previous exam. |
Generate impression based on findings. | History of thyroid cancer. Rule-out adenopathy or recurrence. Status post thyroidectomy. An echogenic focus is again seen posterior to the right thyroid bed which is unchanged and measures 6 x 4 x 8 mm.LYMPH NODES: No significant abnormality noted. | 1.No evidence of residual or recurrent disease.2.No change in the echogenic lesion posterior to the right thyroid bed, which most likely represents the fatty hilum of a lymph node. |
Generate impression based on findings. | 2-year-old male with altered mental status requiring intubation. Evaluate ET tube placement, focal findings.VIEW: Chest AP (one view) 2/16/2015 5:41 ET tube below the thoracic inlet and above the carina. Feeding tube tip coursing below the left hemidiaphragm extending beyond the inferior margin of the image. Left-sided aortic arch, cardiac apex and stomach. Cardiothymic silhouette is normal. Segmental right upper lobe atelectasis as well as in the left lower lobe. No focal pulmonary opacity. No pleural effusion or pneumothorax. | ET tube below the thoracic of the above the carina. Atelectasis in the right upper and left lower lobe. |
Generate impression based on findings. | 2-year-old male with tachypnea, Belly breathing, febrile. Evaluate for pneumonia.VIEWS: Chest AP/lateral (two views) 2/16/2015 Cardiothymic silhouette is normal. Mild peribronchial wall thickening with minimal subsegmental atelectasis in the right lower lobe and left lower lobe. No focal pulmonary opacities. No pleural effusion or pneumothorax. | Reactive airway disease or bronchiolitis. |
Generate impression based on findings. | Reason: h/o salivary carcinoma s/p resection and +surgical margins and +LN, currently being admitted for chemo/rad; eval for residual dx prior to chemo History: h/o salivary carcinoma CHEST:LUNGS AND PLEURA: Scattered punctate micronodules are stable.Mild bronchial wall thickening is present in the lower lung zones.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Severe coronary calcifications.CHEST WALL: Mild degenerative abnormalities affect the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple large renal cystlike hypodensities, stable and likely benign.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Vascular calcifications are present.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Calcified mesenteric lymph nodes presumably from prior granulomatous disease.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastases. |
Generate impression based on findings. | There are stable posttreatment findings with mild asymmetry at the base of the tongue and right-sided volume loss. There is no evidence of recurrent tumor or significant cervical lymphadenopathy. Reference right level IIa lymph node measures 5 x 5 mm on series 4 image 148, unchanged. There is air refluxed into the left parotid duct and parotid gland from "puff cheek" maneuver. The thyroid and major salivary glands are otherwise unremarkable. The major cervical vessels are patent. There are multilevel cervical degenerative changes with right-sided facet arthropathy at a few levels. The osseous structures show no focal lesion. The airways are patent. The imaged intracranial structures are within normal limits. There is increased right maxillary sinus opacification. The imaged portions of the lungs are clear. | Stable post treatment findings without locoregional tumor recurrence or significant cervical lymphadenopathy. |
Generate impression based on findings. | FractureVIEWS: Right ankle AP/oblique/lateral (3 views) 2/16/2015 0842 Sclerosis and periosteal reaction are again seen along a healing distal tibial metadiaphyseal fracture. The fracture line is less distinct compatible with interval healing. The bones are in anatomic alignment. No soft tissue abnormalities identified. | Healing distal tibial fracture. |
Generate impression based on findings. | Reason: eval for lung lesions History: hx of L thigh myxoid liposarcoma LUNGS AND PLEURA: No suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.CHEST WALL: No axillary lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | 77-year-old man with metastatic colon cancer currently on drug holiday. CHEST:LUNGS AND PLEURA: No significant abnormality noted-- stable appearance to calcified right lower lobe granuloma. No abnormality suspicious for metastatic disease. No pleural disease.MEDIASTINUM AND HILA: Marked coronary artery calcification seen an atherosclerotic calcifications in the aorta. No abnormal masses or adenopathy seen.CHEST WALL: Right anterior chest wall Port-A-Cath with tip of catheter in the distal superior vena cava. No other abnormalities.ABDOMEN:LIVER, BILIARY TRACT: Presumed liver metastases are again seen at several locations in the liver. The reference caudate lobe lesion (series 3, image 98) measures 1.0 x 0 .9 cm, previously 1.3 x 1.1 cm. The larger right lower lobe lesion (series 3, image 104) is unchanged measuring 3.8 x 2 .9 cm, previously 3.6 x 2.9 cm. No new foci are seen else where in the liver.Portal and hepatic vessels all appear normal. Gallbladder and biliary tract again show septated gallbladder without other significant abnormality.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications in the aorta again seen. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Orally administered contrast delineates normal-appearing stomach, small bowel and right colon with extensive feces throughout the remainder of the colon without intrinsic abnormality seen. No free mesenteric fluid is seen. Prior referenced right mesenteric lymph node (series 3, image 138) is unchanged measuring 1.3 x 0 .7 cm, previously 1.2 x 0.7 cm.BONES, SOFT TISSUES: Degenerative skeletal disease seen without focal abnormality otherwise noted. 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: Degenerative skeletal changes seen without other significant abnormality notedOTHER: Prior noted thrombus in the right femoral vein is no longer seen. Venous structures now appear normal. Left inguinal hernia containing only mesenteric fat. | 1. Stable appearance to metastatic liver disease and referenced mesenteric lymph node. No new abnormal suspected metastatic lesion seen. 2. Resolution of prior noted right femoral vein thrombus with normal-appearing venous structures currently. |
Generate impression based on findings. | Female 67 years old Reason: assess for colon cancer recurrence History: N/A CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver, unchanged. Simple liver cyst at the edge of the right lobe of the liver is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: There is an ill-defined hypodense lesion in the head of the pancreas measuring 2.2 by 2-cm image number 105, series number 3. This lesion does not cause any upstream pancreatic ductal dilatation and is unchanged from previous study. This may represent focal fat infiltration of the pancreas or a cystic lesion. Further evaluation with MRI is recommended.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Simple appearing right renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes in the rectum..BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Diffuse fatty infiltration of the liver and simple hepatic cyst.Stable hypodense lesion in the head of the pancreas which may represent focal fatty infiltration versus a cystic lesion. Further evaluation with MRI of the pancreas is recommended. |
Generate impression based on findings. | Redemonstrated is a heterogeneous area of abnormal signal in the right posterior frontal centrum semiovale with a popcorn like appearance containing central heterogeneous intrinsic T1 hyperintensity and is somewhat ill-defined T2 hypointense rim which is peripheral to T2 hyperintensity. There is no significant superimposed enhancement. There is significant blooming of the lesion on susceptibility weighted and gradient echo imaging, consistent with a cavernoma. The lesion again measures 1.0-cm transverse by 1.3-cm AP by 1.1 cm CC.There are numerous additional areas of susceptibility corresponding to cavernomas. These are located just inferior to the left dentate nucleus, the left cerebellar hemispheric gray matter, right occipital pole, and largest in the right pons. Initial postcontrast images demonstrate a right pontine lesion demonstrates mild diffuse enhancement extension of tubular enhancement extending ventrally towards the prepontine cistern. More delayed post contrast images redemonstrate subtle curvilinear central enhancement. As before, there is mild expansion of the right side of the pons with intrinsic mildly heterogeneous T1 hypointensity. This lesion has stippled appearance on T2-weighted images and mild T2/FLAIR hyperintensity, therefore an underlying capillary telangiectasia is not excluded. A previously demonstrated possible additional tiny cavernoma in the right anterior cerebellum has an appearance on the current study that more resembles a vessel. A small lesion is also noted in the left occipital periatrial white matter. Even smaller foci are seen scattered elsewhere especially along the parietal convexities.The ventricles and sulci are unchanged in appearance. The cisterns remain patent. There is no midline shift or mass effect. There is restricted diffusion to suggest acute ischemia. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Previously demonstrated left parietal scalp swelling has resolved. | Findings consistent with numerous supratentorial and infratentorial cerebral cavernous malformations with no MRI evidence of new hemorrhage or new perilesional edema. A right pontine lesion may have a superimposed/associated capillary teleangiectasia. |
Generate impression based on findings. | Female 65 years old Reason: left flank pain History: left flank pain ABDOMEN:LUNG BASES: Mild dependent atelectasis.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Left distal ureteral calculus measuring up to 7 mm (series 3, image 134) with moderate to severe hydronephrosis and hydroureter. There is associated peri-nephric and peri-ureteral fat stranding. 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: Metallic screws and fixation device in the L4 and L5 vertebral bodies with surgical clips.OTHER: No significant abnormality noted | Obstructing left distal ureteral stone causing moderate to severe hydronephrosis. |
Generate impression based on findings. | 68 years, Male. Reason: abdominal pain History: as above Residual contrast within the colon. Dobbhoff catheter with tip coiled in the gastric fundus. Nonobstructive bowel gas pattern. | Dobbhoff catheter with tip coiled in the gastric fundus. Nonobstructive bowel gas pattern. |
Generate impression based on findings. | FractureVIEWS: Left wrist PA/lateral (two views) 2/16/2015 0946 Splint material obscures fine bone detail. Buckle fracture of the distal radius is again seen. The fracture line is less distinct compatible with interval healing. The bones are in anatomic alignment. | Healing distal radial fracture. |
Generate impression based on findings. | 38 years, Female. Reason: gastric distension History: nausea and vomiting Surgical staples projected over the right paracentral abdomen. Prominent small bowel loops measuring up to 3.0 cm. The appearance is consistent with postoperative ileus. | Prominent small bowel loops consistent with ileus given patient's postsurgical state. |
Generate impression based on findings. | Female 66 years old Reason: 66 yo F with h.o dermatomyositis with dysphagia History: dysphagia Double contrast evaluation of the esophagus revealed a moderate-sized cricopharyngeal bar, reducing the esophageal lumen by approximately 50%. No hiatal hernia was identified. There was vestibular penetration with trace aspiration which was silent but cleared with coughing. Fluoroscopic examination of esophageal motility revealed breakup of the primary contraction at the midesophagus with delayed initiation of the secondary wave (cine images; series 6, image 49; series 7, 54). There was delayed clearing of barium from the oesophagus. Tertiary contractions were noted. This constellation of findings constitutes a moderate motility abnormality. No gastroesophageal reflux was identified. Limited images of the stomach demonstrated no ulceration or mass. | 1. Moderate esophageal motility abnormality. 2. Cricopharyngeal bar. 3. There was vestibular penetration with trace aspiration which was silent but cleared with coughing.Fluoro time: 7:22 |
Generate impression based on findings. | Male 64 years old Reason: 64 y/o M with R rib pain eval for fracture History: as above. Overlying stool limits sensitivity of the study, however, no definite rib fracture is identified. | No definite rib fracture. |
Generate impression based on findings. | 65-year-old male. Cough. Evaluate for pulmonary infiltrates. LUNGS AND PLEURA: Focal opacities in the right middle lobe and lingula on prior CXR correspond to areas of subsegmental atelectasis and/or scarring which may be post infectious in etiology. Associated mild bronchiectasis with the right middle lobe atelectasis.No obstructing endobronchial lesion is identified. No evidence of active infection or lung malignancy.No pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Normal heart size without pericardial effusion.No visible coronary artery calcification.CHEST WALL: Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Numerous fluid attenuation hepatic foci are consistent with cysts. Additional subcentimeter hypodense hepatic foci are too small to characterize, but likely also cysts. | Focal opacities in the right middle lobe and lingula on prior radiograph corresponds to areas of atelectasis and/or scarring. No evidence of active infection or lung malignancy. |
Generate impression based on findings. | Female 75 years old Reason: L distal radius fracture splinted at OSH, evaluate fracture History: see above. Overlying casting material obscures fine bony detail. There is a distal radial fracture with minimal medial displacement of the distal fracture fragment. There is extension to the articular surface. There is surrounding callus formation compatible with partial healing. An ulnar styloid fragment is seen as well. The carpal bones are intact. | Partial healing of intraarticular distal radial fracture as described above. |
Generate impression based on findings. | Left-sided calvarial changes are consistent with prior craniotomy. There is no MR evidence of underlying residual hemorrhage or for underlying parenchymal abnormality. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. | Left-sided calvarial changes are consistent with prior craniotomy. There is no MR evidence of underlying residual hemorrhage or for underlying parenchymal abnormality. |
Generate impression based on findings. | Female 60 years old Reason: osteomyelitis? History: exposed wound. Postsurgical changes compatible with partial amputation of the left foot. There are large soft tissue defects with exposed bone seen at the fifth metatarsal and calcaneus. There is diffuse demineralization. There are severe vascular calcifications. | Areas of soft tissue defects resulting in exposed bone as described above, compatible with osteomyelitis. |
Generate impression based on findings. | Ms. Bushnell is a 53 year old female with a personal history of bilateral cyst aspirations. Family history of breast cancer in paternal aunt. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Bilateral focal asymmetries are stable when compared to prior examinations, likely representing waxing and waning cysts as documented on prior ultrasound examinations. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | Bilateral benign focal asymmetries. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Increased oxygen requirementVIEW: Chest AP 2/16/15 Tracheostomy tube in place. NG tube tip in the stomach. Cardiothymic silhouette normal. Right upper lobe atelectasis new from prior study on a background of chronic lung disease. No pleural effusion or pneumothorax. | Right upper lobe atelectasis new from prior study on a background of chronic lung disease. |
Generate impression based on findings. | Female 60 years old Reason: osteomyelitis? History: exposed bone Two views of the right hand demonstrate heavy vascular calcifications. There is soft tissue thinning and possible defect at the distal fourth digit. However, there are no underlying cortical defects to suggest osteomyelitis.Two views of the left hand demonstrate amputation of the third digit, with soft tissue reticulation and loss of the cortical margin of the underlying proximal phalanx compatible with osteomyelitis. There are heavy vascular calcifications. | 1. Osteomyelitis of the left fourth proximal phalanx as described above. 2. No radiographic evidence of osteomyelitis of the right hand. However, early osteomyelitis cannot be ruled out and if there is continued clinical concern, an MRI or triple phase bone scan would be of consideration for further evaluation. |
Generate impression based on findings. | Left shoulder mass. Severe pain. Prior biopsy showing lymphoma. The large soft tissue mass compatible with biopsy-proven lymphoma occupies and destroys the majority of the scapula, including the body, coracoid, and glenoid. Though this mass is difficult to measure on non-contrast CT, it likely measures at least 14 cm TV x 12 cm AP x 11 cm CC. There is no humeral head subluxation. The humerus is unremarkable. The AC joint is intact. Inferior and superior to this mass, numerous additional soft tissue masses are noted along the chest wall, likely also representing lymphoma. The conglomeration of masses inferior to the scapula extends over 10 cm in CC dimension. For reference, one of these masses at the caudal aspect of this conglomeration measures 4.8 x 3.8 cm (series 80496, image 82). | Destructive left scapular mass with satellite masses, as above. |
Generate impression based on findings. | Prematurity evaluate infectionVIEW: Chest AP 2/16/15 Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. Left lung opacities may be secondary to atelectasis or infection. No pleural effusion or pneumothorax. | Left lung opacities may be secondary to atelectasis or infection. |
Generate impression based on findings. | Reason: h/o oral tongue ca and CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Minimal apical pleural scarring, likely related to radiation.No suspicious pulmonary nodules or masses.Minimal dependent atelectasis. No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. Moderate coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative disease of the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | Pain Persistent mildly depressed comminuted and intra-articular radial head fracture without significant change in alignment. Again approximately 2 to 3 mm of depression compared to the articular surface is again observed. Small effusion persists | Radial head fracture with unchanged depression of the fracture fragments |
Generate impression based on findings. | 65 year old female with recent right breast biopsy revealed intraductal papilloma with atypia, presents for wire localization procedure prior to the surgical biopsy. On review of the prior studies, focal asymmetry is present in the right retroareolar region with a marker clip, which is the target of this procedure.The procedure, risks including bleeding and infection, and benefits of needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The right breast was placed in an alphanumeric grid using lateral to medial approach. When the target was positioned in the aperture of the grid, the skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using coordinates from the grid, a 5 cm Kopans needle was placed adjacent to the clip. On orthogonal digital mammography, adequate positioning of the needle was confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the target. A spring wire was then deployed. Repeat two view orthogonal digital mammograms reveal the spring wire to be in good position. The digital mammogram was annotated and reviewed with Dr. Jaskowiak prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. Dr. Abe performed the procedure.Orthogonal digital specimen radiographs revealed the focal asymmetry and clip and spring wire to be within the specimen. | Successful needle localization of the right breast clip.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Male 48 years old Reason: abscess; worsening hepatic lesion History: s/p accident removal biliary drain in epigastric region, worsening abd pain. History of cholangiocarcinoma. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Interval increase in size of the ill-defined hepatic segment 6 lesion, which may be confluent with adjacent lesions, now measuring 2.2 x 2.5 cm (series 3, image 51), previously 1.5 x 1.9 cm. Ill-defined hypoattenuating mass at the hepatic hilum is stable in size now measuring approximately 2.8 x 4.3 cm (series 3, image 43), previously 3.0 x 4.4 cm.There are new hypoattenuating lesions scattered throughout the hepatic parenchyma, suspicious for intrahepatic metastases or extension of primary neoplasm. For reference, new lesion in the left hepatic lobe measures 1.0 x 1.2 cm (series 3, image 40).Stable diffuse biliary ductal dilatation. Redemonstrated are two right upper quadrant percutaneous biliary drainage catheters, unchanged in position with the tips terminating within the second portion of the duodenum. Interval removal of epigastric percutaneous biliary drain.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Stable mesenteric lymphadenopathy, reference midline mesenteric lymph node now measures 1.1 x 1.6 cm (series 3, image 66), previously 1.0 x 1.6 cm. Scattered retroperitoneal lymph nodes appear similar in size compared to the prior examination, reference aortocaval node measures 1.1 x 1.7 cm (series 3, image 57), previously 1.2 x 1.8 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.New and increased hypoattenuating lesions in the hepatic parenchyma, suggestive of progression of intrahepatic metastases or spread of primary neoplasm.2.Stable hepatic hilar mass.3.Unchanged right upper quadrant biliary drainage catheter with interval removal of epigastric biliary drainage catheter. Stable diffuse intrahepatic biliary ductal dilatation.4.Stable mesenteric lymphadenopathy. |
Generate impression based on findings. | Reason: sinus infection pre-induction chemo for new acute leukemia? (CT chest also ordered) History: baseline pre-chemo The ostiomeatal complex units are patent bilaterally. Within the nasal cavity no obstructive lesions are appreciated.The frontal sinuses are clear.Maxillary sinuses are clear. Ethmoid air cells are clear . Sphenoid sinuses are clear. Visualized portions of the mastoid air cells and middle ears are clear. Visualized orbits are intact and the visualized intracranial structures are within normal limits. | CT of the paranasal sinuses is within normal limits. |
Generate impression based on findings. | 52 year-old woman with left breast masses and enlarged left axillary lymph node. Ultrasound guided biopsies of the two breast masses and an axillary node are requested. Left ultrasound re-identified the target breast lesions for biopsy. The index lesion to be targeted is a hypoechoic mass measuring 2.0 cm at the 1 o’clock position with increased vascularity, 10 cm from the nipple. The lesion was readily visible.The satellite lesion to be targeted is a hypoechoic mass measuring 0.5 cm at the 1 o’clock position without increased vascularity, 7 cm from the nipple. The lesion was somewhat subtle.Left ultrasound re-identified the target lymph node for biopsy. It was in the medial axilla. Bipolar maximum dimension was 3.6 cm and no non-hilar cortical blood flow was seen on color flow imaging. The target node was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The left breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a lateromedial approach, four 12-gauge core needle (celero) specimens were obtained of the index lesion. Targeting was judged excellent. Three specimens sank to the bottom of the prefilled container of 10% formalin. One specimen was fragmented. Specimen quality was judged excellent.Next, using continuous ultrasound guidance and a lateromedial approach, four 12-gauge core needle (celero) specimens were obtained of the satellite lesion. Targeting was judged excellent. Four specimens partially sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged fair.Using aseptic technique, continuous ultrasound guidance and lateral to medial approach, a 14-gauge core needle (Achieve) was directed into the target node and four specimens were obtained, using the open-trough technique. Samples were obtained centrally through the hypoechoic cortex and at the periphery. Targeting was judged excellent. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged excellent. Whitish tissue was noted throughout all specimens.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the index lesion, a Bard ribbon clip was placed into the satellite lesion, and a Hydromark clip was placed into the axillary lymph node in the usual manner (each clip was placed at the conclusion of sampling each lesion). Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital left MLO, spot, CC and ML views revealed the percutaneously placed clips to be in the expected location in the central aspect of the index lesion, inferior peripheral aspect of the satellite lesion, and the central aspect of the axillary lymph node. No evidence of significant hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and left the Breast Imaging Department in stable condition.The procedures were performed by Drs. Schacht and Patel. Dr. Schacht was present during the procedure at all times. | Successful ultrasound-guided core biopsy of two left breast lesions and clip placements. Successful ultrasound guided core biopsy of an abnormal left axillary lymph node. Suspicion for metastatic involvement is high. Pathology is pending at this time.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Female 30 years old Reason: concerning for biliary process causing abdominal pain, therefore needing RUQ US History: has cyclic vomiting syndrome and chronic abdominal pain, want to evaluate for biliary cause of pain LIVER: Liver measures 12.8 cm. Normal echogenicity. No focal lesions.BILIARY TRACT: No evidence of gallstones or biliary dilatation.PANCREAS: Not well-visualized due to overlying bowel gas.SPLEEN: No significant abnormalities noted. Spleen measures 8 cm.RIGHT KIDNEY: No significant abnormalities noted. OTHER: No significant abnormalities noted. | Unremarkable study. |
Generate impression based on findings. | Reason: Evaluate size of right upper nodule noted to be 3 mm on outside CT scan done in August 2014 History: none LUNGS AND PLEURA: A cluster of pulmonary micronodules in the right upper lobe, the largest measuring just under 3 mm (series 5, image 97). No suspicious pulmonary nodules or masses.Mild basilar subsegmental scarring/atelectasis. No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. No visible coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Scattered subcentimeter hepatic hypodensities, likely benign cysts. | No acute cardiopulmonary abnormality. A cluster of pulmonary micronodules in the right upper lobe, the largest measuring just under 3 mm, likely related to previous infection. Unless the patient is at high risk due to smoking or other exposures, further CT follow up is not recommended for incidental nodules of this size and morphology. |
Generate impression based on findings. | CT for evaluation of lung cancer. History of NHL. LUNGS AND PLEURA: Stable postsurgical findings of left lower lobectomy.Right upper lobe micronodule, unchanged from 2010 and most likely benign.No suspicious nodules or masses.MEDIASTINUM AND HILA: Anterior mediastinal density is 1.8 x 1.1 cm, unchanged (series 3, image 32), may represent residual thymic tissue, post treatment change, or thymic hyperplasia.No new mediastinal or hilar lymphadenopathy. Left vertebral artery arises from the aortic arch, representing normal variant anatomy.Normal heart size without pericardial effusion.CHEST WALL: No axillary lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Two small hepatic hypodensities, unchanged and likely cysts. Cholecystectomy clips.Status post splenectomy with stable residual small accessory spleens. | No evidence of recurrent disease or metastases. |
Generate impression based on findings. | Ms. Hudspeth-Porter is a 53 year old female with a personal history of multiple cysts and bilateral cyst aspirations. Family history of breast cancer in mother, diagnosed at the age of 45. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Bilateral focal asymmetries are stable to slightly smaller when compared to prior exams, compatible with waxing and waning cysts as seen on prior ultrasounds. Scattered benign calcifications are present bilaterally. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | Bilateral benign calcifications. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram with tomosynthesis is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Male 64 years old Reason: 64 y/o M w/ PMH of CHF (presenting with acute decompensation) s/p fall, please eval for fracture History: as above, ecchymosis over R hip. Degenerative changes of the bilateral hips with joint space narrowing and osteophytes at the bilateral acetabular joints. Degenerative arthritic changes also affect the bilateral sacroiliac joints and the pubic symphysis. There is no acute fracture or dislocation. A right vascular stent is noted. | No acute fracture or dislocation. Moderate degenerative arthritic changes as above. |
Generate impression based on findings. | Pain, check for fracture healing A suspected intra-articular comminuted and mildly impacted distal radial fracture appears similar to prior study. Persistent diffuse soft tissue swelling and no change in alignment. No new abnormality | Distal radial fracture as described and grossly unchanged |
Generate impression based on findings. | Right-sided tenderness to palpation LIVER: Enlarged liver, measuring 20.1 cm, with normal echogenicity. No evidence of a hepatic mass.GALLBLADDER, BILIARY TRACT: Normal appearing gallbladder and common bile duct diameter.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: Normal size and echogenicity.LEFT KIDNEY: Normal size and echogenicity. A single cystic lesion within the inferior pole and measuring 2.4 x 1.6 cm likely represents a benign renal cyst.OTHER: The spleen is enlarged measuring17.2 cm. No evidence of splenic masses. | 1.Hepatosplenomegaly.2.Normal appearing gallbladder.3.Benign appearing left inferior pole renal cyst.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Male 61 years old Reason: R/O osteo History: R foot ulcer 1st toe, pain, swelling. Two to overlying structures, details of the area of concern are limited on this study. At the plantar surface is a soft tissue defect underlying the first metatarsal is compatible with an ulcer, without a definitive tract extending superiorly towards the bones. | Soft tissue ulcer of the right foot. No definite radiographic evidence of osteomyelitis. However, early osteomyelitis cannot be ruled out and if there is continued clinical concern, a low threshold for obtaining an MRI or triple phase bone scan is recommended. |
Generate impression based on findings. | Patient fell, check for fracture Ankle: Mild diffuse soft tissue swelling with minimal degenerative changes. No superimposed acute abnormality, specifically no findings to suggest a fractureWrist: No radiographic abnormalityShoulder: Minimal osteoarthritic for small osteophytes and sclerosis. Changes are most pronounced in the glenoid. Alignment and osseous structures are otherwise intact. | Mild shoulder and ankle osteoarthritis without additional superimposed acute abnormality. Specifically no findings to suggest fracture or dislocation |
Generate impression based on findings. | Pain and mass involving thumb Thumb: Mild basilar degenerative changes with more minimal changes involving the first MCP. No superimposed acute abnormality. Alignment preserved. Specifically there is a soft tissue prominence overlying the base of the first metacarpal and either ultrasound or MR imaging may be indicated given non-radiopaque characteristics. Please also compare with opposite hand to ensure asymmetry and correlation with site of symptoms.Hip: Unchanged moderate osteoarthritic changes with narrowing, sclerosis osteophytes and subchondral cysts. Preservation of overall femoral head shape with more mild 08 changes of the SI joint, incompletely visualized and similar | Moderate hip osteoarthritis with more mild changes involving the thumb, see detail provided above |
Generate impression based on findings. | Reason: metastatic disease? History: HCC LUNGS AND PLEURA: Multiple calcified nodule in the right middle lobe with calcified hilar lymph nodes, compatible with previous granulomatous infection.No suspicious nodules.MEDIASTINUM AND HILA: Calcified right hilar and subcarinal lymph nodes compatible with previous infection.No visible coronary artery calcification.No pericardial effusion.CHEST WALL: Bilateral mammoplasties.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Right hepatic hypodense mass measuring 24 x 15 mm (series 2/311) mass, compatible with a history of HCC.Status post cholecystectomy. | No sign of thoracic metastases. |
Generate impression based on findings. | Reason: 49y/o female with breast cancer; checking for metastasis History: breast cancer LUNGS AND PLEURA: Scattered small cystlike lucencies in the right upper lobe may be early centrilobular emphysema or be related to scarring.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Large bilateral breast masses consistent with known breast cancer. Skin ulceration on the left. Additional nodule in the medial inferior left breast. Left axillary lymphadenopathy highly suggestive of malignancy. Small right axillary nodes, nonspecific.Heterogeneous area of lucency and sclerosis in the anterior T11 vertebral body is nonspecific. Correlate with findings of bone scan.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Multiple well-circumscribed lucencies in the liver are partially visualized. They measure near water density and are more typical of cysts than metastases. | 1. No evidence of pulmonary metastases.2. Heterogeneous area of lucency and sclerosis in the anterior T11 vertebral body is nonspecific. It may represent a hemangioma though metastatic disease cannot be excluded. Correlate with findings of bone scan which will be reported separately.3. Large bilateral breast masses consistent with known breast cancer. Skin ulceration on the left. Additional nodule in the medial inferior left breast. Left axillary lymphadenopathy highly suggestive of malignancy. Small right axillary nodes, nonspecific.4. Multiple well-circumscribed lucencies in the liver are partially visualized. They measure near water density and are more typical of cysts than metastases though continued follow up is recommended. |
Generate impression based on findings. | Male 55 years old Reason: Rule out osteo History: foot drainage Three views of the left foot demonstrate no evidence of cortical destruction or periosteal reaction to suggest osteomyelitis. There is diffuse mild swelling of the soft tissues. There is a hallux valgus deformity. Three views of the right foot demonstrate no evidence of cortical destruction or periosteal reaction to suggest osteomyelitis. There is diffuse mild swelling of the soft tissues. There is a hallux valgus deformity. | No radiographic evidence of osteomyelitis. If specific site of concern is identified, this may increase sensitivity of study. However, early osteomyelitis cannot be definitively ruled out, and if there is continued clinical concern, an MRI or triple phase bone scan is recommended. |
Generate impression based on findings. | Ms. Lyons is a 41 year old female with a personal history of benign left breast biopsy in February 2014 for a fibroadenoma. She presents today for a short-term follow-up for an additional high probability benign mass in both breasts. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A circumscribed mass in the right and left central breast is unchanged. A ribbon clip is present in the anterior 8 o'clock position of the left breast, correlating to the biopsy proven fibroadenoma.There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Persistent jaundice and and hyperbilirubinemia. Evaluate the Liver for obstruction, and duplex of vasculature for signs of thrombosis and IVC for dilatation. LIVER: The liver has a smooth contour. Liver measures 16 cm in length. The parenchyma is mildly echogenic. No focal hepatic lesions. Main portal vein is patent with normal directional flow.GALLBLADDER, BILIARY TRACT: The gallbladder contains minimal layering sludge. Wall measures 2 mm in thickness. No pericholecystic fluid. Common duct measures 3 mm and 5 mm more distally. PANCREAS: The pancreas is obscured due to bowel gas.RIGHT KIDNEY: The right kidney measures 12 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. The left kidney measures 11 cm. The cortex is echogenic. No shadowing calculi or hydronephrosis is present. SPLEEN: The spleen measures 10.8 cm. in length. OTHER: Trace perihepatic ascites and small pleural effusion. | No evidence of biliary dilatation. Small amount of sludge in the gallbladder.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Back pain Posterior fixation and mild antral listhesis of what appears to be and previously reported as L4 on 5 (suspect hypoplastic 12th ribs) fixation hardware appears unchanged . Mild end plate depression | Postsurgical changes and mild antero-listhesis reported at the L4-5 level |
Generate impression based on findings. | Female 16 years old; Reason: please assess the subtalar screw placement and medial cuneiform osteotomy History: flatfoot reconstruction with continued postop pain A pes planus deformity is noted. There is an osteotomy and postsurgical fusion of the medial cuneiform. An arthroereisis screw is located within the subtalar joint. An 11 mm area of fragmentation of the medial talar dome likely represents an osteochondral defect. Assessment for loose fragment is limited by CT, though suspected. No fracture is otherwise noted. The soft tissue are unremarkable. | 1. Osteochondral defect at the medial talar dome.2. Post surgical changes, as above. |
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