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Generate impression based on findings. | Male 23 years old Reason: r/o fx History: swelling. We have 3 views of the right wrist which show no fracture.We have 3 views of the right hand which show no fracture. | No fracture evident. |
Generate impression based on findings. | Female 23 years old Reason: assess for intra-abdominal pathology for epigastric and flank pain. History: increased creatinine, bilateral flank pain, abdominal 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 renal or ureteral calculus. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Nonobstructive bowel gas pattern with a normal appendix. No pneumatosis or intraperitoneal free air.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Very distended bladder extending superiorly into the pelvis.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Postsurgical metallic hardware in the right ilium, unchanged. Bilateral acetabular over coverage.OTHER: No significant abnormality noted | Very distended bladder. Correlate for bladder dysfunction. |
Generate impression based on findings. | 15-year-old male punched wall with swelling. Evaluate for fracture VIEWS: Hand PA, lateral, oblique, wrist PA, oblique, lateral (6 views) 2/16/2015 Distal fifth metacarpal metaphyseal fracture with lateral and palmar angulation of the distal fracture fragment. The remaining digits and wrist are normal in appearance and alignment. | Distal fifth metacarpal metaphyseal fracture with lateral and palmar angulation. |
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 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, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | Male 24 years old Reason: eval fx History: s/p assault. We have 3 views of the thoracic spine; we see no fracture or malalignment. | No fracture evident. |
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, version 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Stable skin lesion is again projected over left lower breast. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Female 58 years old Reason: pain History: pain. We have two views of the right hip. Tiny femoral head osteophytes indicate minimal osteoarthritis. The hip otherwise appears normal for patient's age.We have two views of the left hip. There are components of a left hip arthroplasty which appear similar to those seen on the scout radiograph from the 2011 CT scan. The acetabular component is vertically oriented and angled anteriorly, with the head and the femoral component positioned eccentrically within the acetabular component. There is expansile remodeling of the acetabulum that may represent chronic particle wear osteolysis. There are innumerable metallic densities within the soft tissues representing shot pellets. These findings are unchanged from 2011. There is bony deformity and expansile remodeling of the proximal femur that presumably represents a combination of old trauma and chronic loosening. We see no acute abnormality.Four views of the right knee show small osteophytes indicating mild osteoarthritis, essentially within normal limits for patient's age.We have 4 views of the left knee. The bones appear demineralized. There is an orthopedic pin within the patella, presumably affixing a healed fracture. Deformity and elongation of the patella is presumably due to old trauma. Mild to moderate osteoarthritis affects the knee. Cement density is noted within the distal femoral diaphysis. The joint line of the left knee is approximately 6 cm above that of the right knee, which may represent a leg length discrepancy or an artifact of contracture.We have 3 views of the right ankle. There is a well corticated ossicle distal to the fibula that is present on the prior study, and may represent old trauma; we see no acute fracture. Osteophytes at the tibiotalar and talonavicular joints indicate mild osteoarthritis.We have 3 views of the left ankle. The bones appear demineralized. There is a mild deformity of the distal tibia, likely representing an old healed fracture. A small sclerotic focus in the distal tibial diaphysis likely represents a small focus of chronic bone infarction. Mild osteoarthritis affects the ankle joint. | 1.Left hip arthroplasty as described above, with findings that may represent particle wear osteolysis and/or loosening.2.Additional post traumatic and osteoarthritic changes as described above. |
Generate impression based on findings. | 35-day-old male with history of right upper lobe atelectasisVIEW: Chest AP (one view) 2/17/15 5:54 Persistent right upper lobe atelectasis and perihilar/basilar streaky opacities. No pleural effusion or pneumothorax.The cardiothymic silhouette is normal. | Persistent right upper lobe and basilar atelectasis. |
Generate impression based on findings. | 6 day old male with pneumoperitoneum. Assess Penrose drain replacementVIEW: Abdomen AP (one view) 2/17/2015 2:09 Interval placement of Penrose drain which courses from the right lower quadrant and terminates at the left upper quadrant. NG tube with side port above the GE junction. Umbilical arterial catheter tip at T6 vertebral body level. Umbilical venous catheter tip in the right atrium.Paucity of bowel gas. Residual pneumoperitoneum noted below the diaphragm. Diffuse bilateral lung haziness unchanged. | 1. Penrose drain terminates at the left upper quadrant. Residual pneumoperitoneum is noted. 2. NG tube with side port above the GE junction. |
Generate impression based on findings. | Reason: ro pe History: chest pain, sob, history of DVT subtherapeutic on ac PULMONARY ARTERIES: No evidence of pulmonary embolism. Main pulmonary artery is normal in caliber.LUNGS AND PLEURA: Moderate to severe apical predominant centrilobular emphysema.A left upper lobe subpleural nodule measures up to 12 x 9 mm (series 10, image 60), increased from the prior exam dated 05/2012. Additional small pulmonary nodules are unchanged dating back to 01/2011.Mild basilar subsegmental scarring/atelectasis. No focal air space consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without significant pericardial effusion. Mild coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: Mild degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Hypoattenuating lesions in the liver and bilateral kidneys, likely benign cysts. | 1.No evidence of pulmonary embolism or other acute abnormality.2.Upper lobe subpleural nodule is increased from the prior exam dated 05/2012. Further followup with PET imaging may be useful to exclude malignancy.3.Emphysema.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Pain. Injury 10 days prior. Radiopaque BB markers are noted over the right lateral inferior ribs, indicating the site of the patient's pain. Cortical irregularity along the anterior aspect of the seventh rib represents a minimally displaced fracture.No pneumothorax. No focal lung opacities. | Minimally displaced anterior seventh rib fracture, without pneumothorax. |
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, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Intramammary lymph node is stable in the left upper outer quadrant.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, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Biopsy proven benign mass with clip is present in the lower inner right breast. Stable circumscribed mass is seen in the right retroareolar region.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, bilateral screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts with a additional bilateral MLO and cleavage views were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty. 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. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, 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, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | There are multiple enlarged mildly hyperenhancing left cervical lymph nodes, several of which demonstrate central hypoenhancement. The largest of these measures 1.2 x 2.1 cm on 5/52 the left level IIb nodal station. Additional enlarged nodes are seen in the left level Ib and IIa nodal stations. In addition, there is a superficial oval low-density structure with irregular enhancement along its medial aspect, abutting the skin surface which appears thickened and slightly hyperenhancing. This structure measures 1.7 x 2.5 cm on 5/67, immediately abutting the posterior and inferior aspect of the left parotid gland. There is mass effect upon the anterior margin of the left sternocleidomastoid muscle which is displaced posteriorly. There is also associated mass effect upon the left internal jugular vein at the level of the new confluent lymphadenopathy, although cervical vessels remain patent. There are no significant intraparotid lymph nodes identified. There is relatively mild stranding of adjacent fat planes.There is also mild right cervical lymphadenopathy, with a right level IIb lymph node measuring up to 1.6-cm.PHARYNX/LARYNX: The palatine tonsils are enlarged bilaterally with a "kissing" appearance, although without heterogeneous appearance. There is also increased soft tissue along the gross year nasopharynx migrating to hypertrophied lymphoid tissue within the adenoids. The nasopharynx, oropharynx, hypopharynx, and larynx are otherwise unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: The postcontrast appearance of the salivary glands is unremarkable. The thyroid gland is unremarkable. ORAL CAVITY: The oral tongue and floor of mouth are unremarkable.OTHER: Mild disconjugate gaze is incidentally noted. There is mild mucosal thickening in the maxillary sinuses. | Significant left cervical lymphadenopathy as detailed above, with mild-moderate localized mass effect. Includes large superficial hypoenhancing oval structure with peripheral enhancement abutting the left parotid gland which may represent a suppurative node which has transformed to an abscess, now abutting the skin surface with mild cellulitic changes. Mild surrounding inflammatory changes. Differential includes suppurative lymph nodes relating to atypical infection such as non-tuberculous mycobacterium, cat scratch disease, or bacterial infection. Malignancy including lymphoma is felt to be less likely. |
Generate impression based on findings. | Fall. Left hip pain. Moderate osteoarthritis affects the hips bilaterally. No fracture or malalignment is present. Degenerative changes are also noted in the symphysis, sacroiliac joints, and visualized lower lumbar spine.A curvilinear metallic density is again noted within the pelvis. | No fracture or malalignment. |
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, version 9.3. The breast parenchyma is heterogeneously dense. A lobulated mass associated with a few calcifications is present at upper outer quadrant in the left breast.No suspicious masses, microcalcifications or areas of architectural distortion are present in right breast. | A lobulated mass associated with a few calcifications at upper outer quadrant in the left breast. Comparison to old mammograms is recommended. If old mammograms are not available, spot compression views and possible ultrasound study are recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: O - Old Study For Comparison. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and an additional right MLO view were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. Pacemaker generator is noted in the right chest wall. 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. | post brain biopsy There is a burr hole on the left frontal bone and a small air indicating postoperative status.In addition, there is a small metallic nodular lesion on the left parahippocampal gyrus which again is postoperative implantation.There is no evidence of acute hemorrhagic lesion on this scan.Diffuse low signal intensity lesions on the left insular cortex, left temporal gyrus, left parahippocampal gyrus and fusiform gyrus, no change since prior exam. The ventricles, sulci, and cisterns are symmetric and unremarkable. The paranasal sinuses and mastoid air cells are clear. | 1. Postoperative status.2. No evidence of acute hemorrhagic lesion.3. No change of left insular cortex, left temporal lobe pole and left parahippocampal gyrus since prior exam. |
Generate impression based on findings. | Female 53 years old Reason: eval peripancreatic fluid collection vs abscess History: upper abd pain, JP drain not draining. History of pancreatic cancer. ABDOMEN:LUNG BASES: Left pleural effusion with overlying atelectasis, unchanged.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Surgically absent.PANCREAS: Changes consistent with prior distal pancreatectomy with the remaining portions of the pancreas unchanged. There is adjacent inflammation in the surgical bed. The left anterior abdominal fluid collection (series 3, image 31) is decreased in size and measures 5.2 x 1.6 cm, previously 4.4 x 2.3 cm. The left percutaneous drain is appropriately located within the collection.The posterior portion of this collection, layering against the left lateral abdominal wall is also decreased in size (series 3, image 32), measuring 3.6 x 1.0 cm, previously 3.5 x 1.6 cm. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Multiple enlarged pericardiophrenic lymph nodes are present.BOWEL, MESENTERY: The cyst-gastrostomy stents, and the nasojejunal tube are in their expected locations. Anterior/incisional hernia without obstruction or bowel wall thickening.BONES, SOFT TISSUES: No significant abnormality noted OTHER: Along the left lower abdominal wall are multiple subcutaneous nodules which appear less prominent, the largest measuring 1.2 x 1.1 cm, previously 1.6 x 1.8 cm (series 3 on image 87). PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postoperative findings of colectomy and ileo-anal pouch are unchanged.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Interval decrease in size of the fluid collection in the distal pancreatectomy surgical bed, with percutaneous drain appropriately positioned.2.Persistent left pleural effusion, unchanged. |
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, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, 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, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of maternal cousin with breast cancer. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, 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, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Stable circumscribed mass is again seen in the lower inner right breast. Scattered benign calcifications are unchanged in both breasts. 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, bilateral screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 12-year-old male, evaluate for fractureVIEWS: Right ankle, AP, lateral, oblique (3 views) 2/17/15 8:21 Alignment is anatomic. There is mild improved soft tissue swelling about the ankle without underlying fracture visualized. The bones are sightly demineralized. | Mild soft tissue swelling without fracture evident. |
Generate impression based on findings. | OHT in 9/2014 presents with positive RSV. Evaluate for bacterial pneumonia. EPIC history: operative note from 9/8/2014, large LV calcified aneurysm eroding through diaphragm into the pleura/peritoneum, which was plicated and left attached to diaphragm. LUNGS AND PLEURA: Small area of consolidation in the right upper lobe against the fissure and nodular patchy solid and ground glass opacities in the right lower lobe, consistent with infection.Medial left lower lobe subsegmental atelectasis.No pleural effusion. Calcified nodules consistent with healed granulomatous disease.Very mild emphysema.MEDIASTINUM AND HILA: Mildly enlarged mediastinal lymph nodes, likely reactive. Calcified mediastinal nodes consistent with healed granulomatous disease.Postsurgical findings of heart transplant. Normal heart size without pericardial effusion. Soft tissue opacity with a rim of calcifications above the left hemidiaphragm, at the apex of the transplanted heart consistent with residual LV calcified aneurysm (series 8027, 107; series 5, image 70), No visible coronary artery calcification. Mild thoracic aorta calcification.CHEST WALL: Median sternotomy with nonunion of sternal fragments and separation measuring up to 10 mm; sternotomy hardware is intact. Age indeterminate compression deformity of T7 vertebral body. Minimal degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Multifocal opacities in the right lung consistent with infection. |
Generate impression based on findings. | 10-year-old male, evaluate for fractureVIEWS: Right Tibia and fibula, AP and lateral (two views) 2/17/15 8:30 Deformity of the distal tibial diaphysis with persistent visualization of an oblique fracture line consistent with a healing fracture. Alignment is anatomic. | Healing fracture of the distal tibia in anatomic alignment. |
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, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Stable benign intramammary lymph nodes 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, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 62 year old female with right cervical pain/swelling and subjective fever. There is asymmetric enlargement of the right parotid gland with asymmetrically enlarged right intraparotid lymph nodes and infiltrative increased attenuation of the gland and induration of the surrounding fat planes. There is no parotid ductal dilation, stone, or fluid collection/abscess. The left parotid, thyroid and submandibular glands appear unremarkable. There are mildly enlarged cervical lymph nodes right greater than left, which are nonspecific and may be reactive. The major cervical vessels are patent. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | 1. Infiltrative changes of the right parotid gland as described above are suggestive of parotitis. No evidence of parotid duct obstruction, stone, or abscess. 2. Mildly enlarged right cervical lymph nodes are most likely reactive. |
Generate impression based on findings. | Female 26 years old; Reason: s/p left thumb MC resection for giant cell tumor, ICBG reconstruction of defect, s/p hardware removal for suspected infection, now with lucency in graft, please evaluate for infection vs. recurrence. The first metacarpal bone graft material and post surgical deformity are again noted. There is fragmentation of the mid diaphysis of the first metacarpal with minimal separation of the proximal and distal portions of bone. The basilar joint and first metacarpophalangeal joints remain articulated. No significant abnormality is otherwise noted. | Fragmentation of the mid diaphysis of the left first metacarpal |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of right breast aspiration and prior benign left biopsy. 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. Biopsy clip noted in the left lower inner breast. Scar marker with mild architectural change is noted in the right breast. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is heterogeneously dense. 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, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Female, 36 years old, with history of myxofibrosarcoma of the neck. Findings related to extensive right neck dissection are again seen including partial right mandibulectomy. The mandibular defect is bridged by bone graft which appears to be incorporated into the native residual mandible. The entire construct is affixed with a plate and screw device which is in stable position. The right submandibular space has been extensively dissected with resection of the submandibular gland. Numerous surgical clips are in place. A soft tissue graft reconstruction is suspected in this location. Deformation and fatty atrophy of the right tongue is unchanged. No suspicious mass or pathologic enhancement is identified in any of these areas to suggest local tumor recurrence.A left level Ib node measures 6 mm short axis (image 34 series 8) not significantly changed from prior. No new or enlarging lymph nodes are seen.The residual salivary glands are unremarkable as is the thyroid. The right IJ vein fails to opacify through the operative regions. No concerning osseous lesions are detected. | Redemonstration of extensive postsurgical findings with no evidence to suggest local tumor recurrence or pathologic adenopathy. |
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, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Scattered benign calcifications and mild arterial calcifications are mildly progressed in benign fashion in both breasts.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, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, 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, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, 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, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is extremely dense, limiting the sensitivity of mammography and increasing the importance of physical examination, unchanged in pattern and distribution. A Hydromark clip is present in the right upper outer quadrant.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. Physical examination is of increased importance for patients with dense breasts. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSD - Screening Mammogram. |
Generate impression based on findings. | Quadriparesis Limited examination, with only one open-mouthed odontoid view provided. The dens is intact. The lateral masses are symmetric, suggestive against Jefferson fracture. | Limited examination, without abnormality evident. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Small mass with biopsy clip in the right upper outer breast is again noted. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Ms. McDonald is a 70 year old female with a personal history of left breast lumpectomy in 2006 for IDC followed by radiation, chemotherapy, and hormonal therapy (Femara). She also had a benign left breast biopsy in 2013. Family history of breast cancer in sister. No current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. 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. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | Expected 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. | CT head: There is generalized cerebral atrophy and marked dilation of the ventricles appearing similar to the prior study from 2013. There is no acute intracranial hemorrhage, mass effect, or midline shift. Periventricular low attenuation is consistent with chronic small vessel ischemic disease. The orbits and paranasal sinuses are unremarkable. The calvarium is unremarkable without fracture. CT lumbar spine: The bones appear demineralized. There is a mild S-shaped lumbar scoliosis. There are compression deformities of L3, L4, and L5 consistent with age-indeterminate compression fractures, with L5 vertebral body and facet fractures appearing acute as described below. There are severe multilevel facet hypertrophic degenerative changes. There is no evidence of compromise of the central canal. There is atrophy of the paraspinal muscles. Atherosclerotic calcifications affect the abdominal aorta and its branches. Severe sacroiliac joint degenerative changes are partially imaged. Additional level specific findings are as follows, within the limitations of CT technique: T12-L1: No significant degenerative disk disease, central canal, or neuroforaminal compromise.L1-L2: No significant degenerative disk disease, central canal, or neuroforaminal compromise. Severe facet degenerative changes. L2-L3: The compression fracture of the superior endplate of L3 involves approximately 30% of the superior endplate. Mild degenerative disk disease, central canal, or neuroforaminal compromise. There is an acute-subacute fracture through the spinous process of L3. Severe hypertrophic facet degenerative changes. L3-L4: There is mild age-indeterminate compression of L4. There are also an acute appearing nondisplaced fractures through the spinous process and right transverse process of L4. Mild degenerative disk disease with a mild disk bulge but no central canal or neuroforaminal compromise. Severe hypertrophic facet degenerative changes with partial facet joint fusion. L4-5: There is a lucent fracture line involving the superior endplate of L5 which is highly suspicious for an acute fracture. This fracture line extends through the superior articulating facets of L5 bilaterally. Moderate degenerative disk disease with a moderate disk bulge but no significant central canal or neuroforaminal compromise. Severe hypertrophic facet degenerative changes with facet joint fusion. There is narrowing of the left neural foramen with partial effacement of the fat surrounding the exiting nerve roots.L5-S1: Moderate degenerative disk disease with a moderate disk bulge but no significant central canal or neuroforaminal compromise. Severe hypertrophic facet degenerative changes with partial facet joint fusion. There is narrowing of the left neural foramen with partial effacement of the fat surrounding the exiting nerve roots.Atherosclerotic calcifications are present branches along the aorta and some of its branches. | 1. No acute intracranial hemorrhage or edema. Asymmetric ventricular enlargement relative to the sulci raises the possibility of normal pressure hydrocephalus, but is not significantly changed since 2013. 2. Acute appearing fractures of the L5 vertebral body as well as the bilateral L4-5 facets and L4 and L3 spinous processes, raise the question of an unstable fracture and possibly associated ligamentous injury. MRI may be helpful to further evaluate if warranted clinically. 3. Acute appearing fracture of the right L4 transverse process. 4. Age indeterminate compression fractures of L3 and L4 and extensive degenerative changes as described above. Acute findings were discussed with Dr. Allison West by phone at 10:30 AM on 2/17/15. |
Generate impression based on findings. | Reason: cerebrovasculature, stroke w/u . Malaise and fatigue Unspecified urinary incontinence. Neck CTA: There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is 30% narrowing proximal left internal carotid artery associated with some hypodense plaque. There is no significant stenosis along the course of the vertebral arteries. Atherosclerotic calcifications are present at the carotid bifurcations.There are multilevel degenerative changes present in the cervical spine with endplate and uncovertebral osteophytes at multiple levels narrowing the spinal canal and neural foramina. This appears to be worse at C3-4 other finding suspicious for spinal stenosis. Other levels suspicious for spinal stenosis at C4-5. There is calcified than was present at the C1 vertebral level.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. There is mild narrowing of the left internal carotid artery at the carotid siphon with approximately 40% narrowing of the left internal carotid artery at the clinoidal segment.The anterior communicating artery and the posterior communicating arteries are identified and are intact. There is fenestration of the anterior communicating artery. The posterior communicating arteries are similar in size to the P1 segments bilaterally.Atherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the distal vertebral arteries. There is extracranial origin of the right posterior inferior cerebellar arteryCT 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.Periventricular and subcortical white matter hypodensities of a mild degree are present.The visualized portions of the paranasal sinuses and demonstrate mild mucosal thickening in thickening of the walls of the maxillary sinuses appear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. There are scleral calcifications present adjacent to the insertion sites of the ciliary bodies most likely representing scleral plaque. | 1.No evidence for cervicocerebral occlusive disease.2.There is 30% narrowing proximal left internal carotid artery associated with some hypodense plaque.3.There are multilevel degenerative changes present in the cervical spine with findings suspicious for spinal stenosis at C3-4 and C4-5. 4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. |
Generate impression based on findings. | Pain. No fracture or malalignment. No ankle joint effusion. No significant abnormality otherwise evident. | No specific findings to account for the patient's pain. |
Generate impression based on findings. | Metastatic urethral cancer. Staging CT. EPIC history: recently admitted for urosepsis, treated with IV Ab. LUNGS AND PLEURA: Post-surgical findings of left upper lobe wedge resection with interval resolution of loculated air/fluid collection adjacent to the suture line.No suspicious pulmonary nodules or masses.New multifocal subpleural groundglass opacities in the upper lobes bilaterally and left lower lobe, Basilar and apical emphysema.MEDIASTINUM AND HILA: Small mediastinal lymph nodes, decreased in size from prior.Normal heart size without pericardial effusion.Moderate coronary artery calcification. CHEST WALL: Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Calcified pericaval lymph node, unchanged. | 1. Decreased size of previously prominent mediastinal lymph nodes.2. No evidence of lung metastases.3. New multifocal groundglass opacities, which may represent drug reaction, aspiration, hemorrhage or atypical infection.An acute exacerbation of the underlying chronic interstitial lung disease is also a possibility. |
Generate impression based on findings. | Frontal sinus: The right frontal sinus is not pneumatized. The left frontal sinus has cleared, with trace mucosal thickening along the left frontoethmoidal recess.Anterior ethmoids: There is slightly improved aeration of the anterior ethmoid air cells, with the right slightly better aerated than the left.Maxillary sinuses: The right maxillary sinus is slightly better aerated in the apex. There is mild mucosal thickening within the left maxillary sinus, slightly increased. The right ostiomeatal unit is opacified while the left is clear. Is again thickening of the walls of the right greater than left maxillary sinus indicating chronic inflammatory changes.Posterior ethmoids: There is similar pattern of mild-moderate mucosal thickening in the posterior ethmoid air cells.Sphenoid sinus: Diffusely increased aerated secretions in the right sphenoid sinus. There is mild mucosal thickening along the left sphenoid sinus with opacification of the sphenoethmoidal recesses although only partial on the left. There is moderate rightward nasal septal deviation with a 3-mm directed rightward bony spur. There is nonspecific opacification in the middle meati bilaterally, in a similar pattern to that of the prior exam which could represent discrete polyps. There is likely a left concha bullosa which is opacified.The lamina papyracea are intact. The roof of the ethmoids is slightly higher on the right. | 1. Mild interval mixed change in aeration of paranasal sinuses as detailed above. Completely opacified right ostiomeatal unit as well as opacified bilateral sphenoethmoidal recesses.2. Areas of masslike opacification in the middle meati which are nonspecific, for which correlation with direct inspection is recommended to exclude polyps. |
Generate impression based on findings. | 6 day old male with possible free air in the midabdomen. Evaluate for intestinal perforation.VIEWS: Abdomen lateral decubitus and crosstable (two views) 2/17/2015 0:10 NG tube tip in the stomach. Umbilical arterial catheter tip at T6 vertebral body level. Umbilical venous catheter tip in the right atrium.Oval-shaped lucency noted along the anterior abdominal wall on crosstable view and at the superolateral aspect of the right upper quadrant on left lateral decubitus view is consistent with free air. Paucity of bowel gas. Diffuse bilateral pulmonary haziness unchanged. | Findings consistent with pneumoperitoneum. Findings were discussed by Radiology on-call resident Dr. Michael Veronesi with surgery team on 2/17/2015 at 12:51 AM. |
Generate impression based on findings. | Male, 33 years old, with diffuse large B-cell lymphoma, pre-stem cell transplant evaluation. The paranasal sinuses are clear and free of significant mucosal thickening or accumulated secretions. There is at most a very small mucous retention cyst in the right maxillary sinus. The major sinus ostia are unobstructed. The nasal septum and turbinates are unremarkable. The nasal cavity is clear. The mastoid air cells and middle ear cavities are also unremarkable. | No evidence of sinus inflammatory disease. |
Generate impression based on findings. | Reason: h/o laryngeal ca, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Apical pleural and pulmonary scarring secondary to radiation therapy. Scattered benign appearing micronodules, some calcified, unchanged. No new suspicious pulmonary nodules or masses.Debris within the trachea. Patchy ground glass opacity with associated local scarring and mild bronchiectasis, most prominent in the left lower and right middle lobes, increased in prominence from the prior exam, suggestive of chronic/recurrent aspiration.No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size without significant pericardial effusion. Severe coronary artery calcification.A right paratracheal lymph node is prominent, measuring up to 8 mm (series 3, image 36), increased from the prior exam, and likely reactive in the presence of worsening aspiration.CHEST WALL: No significant abnormality noted.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. | 1.No evidence of metastatic disease.2.Findings compatible with chronic/recurrent aspiration. |
Generate impression based on findings. | Reason: s/p EDH evac History: HA The patient is status post right-sided craniotomy for removal of a right frontal lobe mass..Since the prior exam the patient has undergone a reoperation through an epidural hematoma at the craniotomy site. Since the prior exam midline shift associated with epidural hematoma has decreased 18 mm to 2 mm. There is some intracranial air underneath the craniotomy flap. There are some blood products present at the region of the tumor bed in the right frontal lobe as well as subarachnoid blood in the right sylvian fissure and over the convexities of the right frontal lobe.. there is soft tissue swelling over the scalp tissues adjacent to the craniotomy site.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Status post recent craniotomy for removal of right frontal lobe tumor and more recently epidural hematoma. Midline shift has significantly decreased since the prior exam. 2.There are attendant postoperative changes present which include some blood products along the subarachnoid space over the convexities of the right frontal lobe and also in the tumor bed. |
Generate impression based on findings. | The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. The scout lateral view and the sagittal reformatted images demonstrate normal alignment of the cervical spine, with straightening of the normal cervical lordosis. The vertebral body and disk space heights are well-maintained.There is no acute fracture.At C1-C2, there is a normal relationship of the dens with the arch of C1. There is slight asymmetric widening of the distance between the lateral mass of C1 and odontoid process on the left as compared to the right, but this is felt to relate to patient head positioning.At C5-C6, there is a very mild disk protrusion without stenosis. The axial images do not demonstrate any other significant disk bulge, disk herniation, significant bony spinal canal or foraminal stenosis.There is minimal pleural parenchymal scarring at the lung apices. There is a single coarse calcification within the right lobe of the thyroid gland. | 1. No acute intracranial abnormality.2. No acute fracture or subluxation. |
Generate impression based on findings. | Follow-up There is diffuse soft tissue swelling. Again seen is a transverse fracture through the base of the fifth metatarsal; the fracture line appears less distinct on the current study than on the prior study, suggesting some interval healing. Old posttraumatic deformities and arthritic changes of the foot appear similar to those seen on the prior study, including lucencies within the bones of the ankle and midfoot that may represent chronic erosions. | Healing fifth metatarsal fracture and other findings as described above. |
Generate impression based on findings. | Reason: s/p tumor resection History: ha Since the prior exam the patient has undergone right-sided craniotomy for removal of a right frontal lobe mass. Patient now has a large epidural collection adjacent to the craniotomy flap measuring 36 mm in thickness and is associated with 18-mm shift of the midline structures towards the left. There are are some minor blood products present at the tumor bed and in the subarachnoid space adjacent to the right frontal lobe.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.There is a new epidural hematoma present adjacent to the craniotomy site associated with approximately 18 mm shift of the midline structures towards the left.2.The patient is status post recent right-sided craniotomy for removal of a right frontal lobe mass. A there are some postoperative changes which include blood products in the tumor bed and subarachnoid space adjacent to the right frontal lobe. |
Generate impression based on findings. | 50 years, Female. Reason: evaluate for ileus v. SBO History: diffuse abdominal pain Cholecystectomy clips right upper quadrant with surgical sutures and surgical staples scattered throughout the abdomen. Gas distended loops of large bowel compatible with large bowel ileus. | Large bowel ileus pattern. |
Generate impression based on findings. | Patient with EGFR mutation, on TKI. Follow-up. CHEST:LUNGS AND PLEURA: Left lower lobe reference nodule is 7 x 22 mm, previously 8 x 20 mm (series 5, image 80), not significantly changed. Additional smaller nodules in the left lung are not significantly changed. This includes a 3 mm nodule adjacent to the major fissure (series 5, image 37), likely an intrapulmonary lymph node.No new nodules are identified.MEDIASTINUM AND HILA: Multiple small mediastinal lymph nodes, unchanged. The reference right paratracheal lymph node is 6 mm in short axis (series 3, image 49), unchanged.Nonspecific small hypoattenuating nodules in the thyroid, some of which are calcified, unchanged.Normal heart size without pericardial effusion.No visible coronary artery calcification.CHEST WALL: Mild to moderate degenerative changes of the thoracolumbar spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholecystectomy clips. No suspicious hepatic mass.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Extrarenal pelvises bilaterally. Right renal cyst.PANCREAS: Stable subcentimeter cystic lesion in the proximal pancreatic body, incompletely characterized, may be a sidebranch IPMN (series 3, image 107).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: Mild to moderate degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted. | Stable disease. |
Generate impression based on findings. | 15 year old female with left lower quadrant pain. Evaluate for stone. VIEW: Abdomen AP (one view) 2/17/2015 Nonobstructive bowel gas pattern. Average stool burden. Punctate density in the left hemipelvis may represent a stone or phlebolith. | Punctate density in the left hemipelvis may represent a stone or phlebolith. |
Generate impression based on findings. | Swelling and pain. Healed? Again seen are 3 orthopedic screws affixing the first tarsometatarsal joint in near-anatomic alignment. I see no hardware complications, and there is bone-on-bone apposition at the articulation. The previously seen orthopedic pin affixing the first metatarsophalangeal joint has been removed. Mild osteoarthritis affects the first metatarsophalangeal joint. | Postoperative changes of first tarsometatarsal joint fixation and other findings as above. |
Generate impression based on findings. | Frontal sinus: The frontal sinus and frontoethmoidal recesses are clear.Anterior ethmoids: There is mild to moderate patchy bilateral anterior ethmoid air cell mucosal thickening and aerated secretions.Maxillary sinuses: There is again trace mucosal thickening in the maxillary sinuses. The ostiomeatal units are clear.Posterior ethmoids: There is mild to moderate patchy bilateral posterior ethmoid air cell mucosal thickening and air in secretions.Sphenoid sinus: The sphenoethmoidal recesses are clear. Previous mucous retention cysts in the sphenoid sinuses have cleared, with only mild residual mucosal thickening.There is mild rightward nasal septal deviation. The nasal turbinate morphology is within normal limits. There is scattered debris within the nasal cavityThe lamina papyracea are intact. The roof of the ethmoids is relatively symmetric. There is again mild-moderate fluid opacification of right mastoid air cells inferiorly. There is trace fluid in the left. | Slight increased opacification and mucosal thickening in bilateral anterior and posterior ethmoid air cells. Resolution of previously seen bilateral sinus mucosal retention cysts. Both ostiomeatal units are patent. |
Generate impression based on findings. | 69-year-old male with history of bladder cancer with neobladder and recent right ureteral reimplantation due to obstruction complicated by urinoma here for evaluation of anastomotic leak at ureteral reimplantation site. The cystogram was performed using Foley Catheter which was inserted by the clinical service. Scout film demonstrated a right nephroureterostomy tube and a pigtail catheter projecting over the right hemipelvis. Surgical clips are noted bilaterally. Cystografin was administered by gravity via the Foley catheter and maximal distention was achieved at 300 mL (1 bottle).The neobladder demonstrated no mucosal abnormality. Vesicoureteral reflux was noted bilaterally up to the the renal pelvis. Delayed images demonstrated extravasation of contrast around the right ureterovesical junction near the pigtail drainage catheter. Post void examination demonstrated residual extravasated contrast in the right hemipelvis. No significant residual contrast was noted in the bladder.TOTAL FLUOROSCOPY TIME: 6:36 minutes | 1.Anastomotic leak at the right ureteral implantation site. 2.Bilateral vesicoureteral reflux as described above.3.Findings were discussed with Dr. Steinberg at 0859 on 2/17/15. |
Generate impression based on findings. | Back pain The bones appear demineralized, suggesting osteopenia/osteoporosis. Mild loss of height of a few mid and lower thoracic vertebrae appears similar to that seen on the prior study. There is also mild to moderate multilevel degenerative disk disease and a mild thoracic kyphoscoliosis that appears similar to the prior study. Degenerative arthritic changes affect the visualized lower cervical spine. | Demineralized bones, vertebral height loss, and degenerative disk disease appearing similar to the prior study. |
Generate impression based on findings. | Reason: to check for any ischemia, abnormalities leading to AMS History: brain stem reflexes only appreciated The CSF spaces are appropriate for the patient's stated age with no midline shift. Atherosclerotic calcifications are present along the distal internal carotid arteries.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 are clear. The visualized portions of the mastoid air cells re-demonstrate opacification of the left mastoid air cells and the middle ear and opacification of the right mastoid air cells . There is thickening of the linigng of the left external auditory canal. The visualized portions of the orbits are intact. The eyeball lenses are thin.A metallic wire entering the nose is coiled in the nasal cavity ,nasopharynx and oropharynx. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction.3.Opacification of the mastoid air cells and left middle ear. Please correlate with physical findings or possible otitis.4.Thickening of the lining of the left external auditory canal is non-specific. This could be inflammatory in nature. Please correlate with physical findings on clinical exam. |
Generate impression based on findings. | Scout radiograph showed a nonobstructive bowel gas pattern and a gastrojejunostomy tube looped overlying the stomach. Barium was first injected into the jejunostomy tube and there was filling of the proximal duodenal bulb as well as some reflux into the gastric antrum. During injection of the gastrostomy tube, there was filling of the gastric body and fundus. On spot images of the progress of barium through the small bowel, the tip of the jejunostomy tube had migrated distally toward the distal descending duodenum and nearly reached the genu.Fluoroscopic evaluation showed normal mucosa throughout the small bowel, with no dilatation, strictures, ulcers, sinus tracts, fistulae, or adhesions. During the examination, the patient had some symptoms of fluid in his mouth, however, no gastroesophageal reflux was observed under fluoroscopy at that time. No separation of bowel loops was present to suggest fibrofatty proliferation. After the findings were discussed with the clinical service, the examination was terminated and the terminal ileum and ileocecal valve were not opacified due to long transit time (over 90 minutes transit without opacification of the cecum) and after small bowel obstruction was excluded. TOTAL FLUOROSCOPY TIME: 6:15 minutes | 1.Jejunostomy tube tip initially at the duodenal bulb with migration distally towards the genu.2.No evidence of small bowel obstruction. |
Generate impression based on findings. | Left hip pain Three views of the left hip are provided. The bones appear slightly demineralized. Tiny osteophytes indicate mild osteoarthritis, essentially within normal limits considering the patient's age.The AP view the pelvis shows mild osteoarthritis affecting both sacroiliac joints and moderate degenerative arthritic changes affecting the visualized lower lumbar spine. | Osteoarthritis as described above. |
Generate impression based on findings. | Reason: f/u from previous History: f/u from previous The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of a subarachnoid hyperdensity in the right sylvian fissure.Hypodense foci are present in the pons and midbrain which are unchanged since the prior exam.Focus of diffusion restriction identified on the recent MRI is not readily appreciated on this examA small focus of encephalomalacia is redemonstrated right cerebellar hemisphere.No abnormal mass lesions are appreciated intracranially.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin. Atherosclerotic calcifications are present along the distal internal carotid arteries. | 1.Examination is essentially stable compared to the prior exam. There is redemonstration of a small amount of subarachnoid blood in the right sylvian fissure. The patient is known to have occlusion of the superior division of the right middle cerebral artery based on MRA.2.A small focus of infarction present along the right parietal lobe is not readily appreciated on this exam possibly related to petechial blood3.Old lacunar infarcts are present in the brain stem involving dominantly pons and midbrain4.small focus of encephalomalacia in the right cerebellar hemisphere. |
Generate impression based on findings. | 73 years, Male. Reason: 73M s/p cystectomy, ileal conduit complicated by partial small bowel obstruction. Failed trial without NGT tube. Now confirm replacement position History: Persistent nausea Note that the pelvis is excluded from the field-of-view. There are multiple dilated loops of small bowel compatible with known small bowel obstruction. No intramural or free air. Enteric feeding tube is looped and projects over the gastric fundus with tip projecting near the gastroesophageal junction. | Enteric feeding tube is looped over the gastric fundus with tip near the gastroesophageal junction. Persistently dilated loops of small bowel compatible with small bowel obstruction. |
Generate impression based on findings. | 69 year male with history of metastatic prostate cancer now with abdominal pain for 4 days, worse with eating, evaluate for obstruction. 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: Left lower lobe solid pulmonary nodule (series 4, image 16) measures 1.0 cm, measured 1.0 cm previously and suspicious for metastasis. Additional right lower lobe subpleural nodule has increased in size.LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Interval placement of bilateral nephroureteral stents. Right-sided hydronephrosis has resolved. There is persistent mild left-sided hydroureteronephrosis. The distal ureters bilaterally are invaded by metastatic lymphadenopathy.RETROPERITONEUM, LYMPH NODES: Extensive retroperitoneal lymphadenopathy. Reference left periaortic lymph node measures 1.7 x 2.1 cm (series 3, image 47), previously 1.5 x 1.9 cm. Reference aortocaval lymph node is inseparable from the IVC and cannot be remeasured on this noncontrast examination. Non-reference retroperitoneal nodes have increased in size.Moderate atherosclerotic disease of the abdominal aorta and branch vessels.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Multifocal sclerotic osseous metastases are again noted, increased from prior. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Heterogeneously enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: Pelvic lymphadenopathy. Left obturator lymph node (series 3, image 113) measures 1.3 by 2.1 cm, previously 1.7 x 2.8 cm. Right external iliac node (series 3, image 117) measures 1.7 x 2.6 cm, previously 2.0 x 2.6 cm.BOWEL, MESENTERY: Extensive mesenteric implants noted adjacent to and invading the rectum (series 3, image 112) measures 3.9 x 5.1 cm, previously 4.7 x 4.8. BONES, SOFT TISSUES: Multifocal sclerotic osseous metastases are again noted, increased from prior. OTHER: No significant abnormality noted | 1.Metastatic prostate cancer. Mesenteric implant invading rectum. Increased retroperitoneal lymphadenopathy. Osseous metastases also appear to have increased, but bone scan would be more sensitive. 2.Interval placement of bilateral nephroureteral stents with resolution of right-sided hydroureteronephrosis. Mild left-sided hydroureteronephrosis persists.3.Basilar pulmonary nodules suspicious for metastases.4.No evidence of bowel obstruction. |
Generate impression based on findings. | There is transitional lumbosacral anatomy, with partial sacralization of the L5 vertebra. There appears be anomalous articulation of the left L5 transverse process with the sacrum. For purposes of this exam, the last fully formed disk is at L4-L5 with a rudimentary disk at L5-S1.The lumbar spine is in normal alignment, with a normal lumbar lordosis. There is mild narrowing at L1-L2 with Schmorl's node formation along the plate of L1. There is also mild disk narrowing at L3-L4 and L4-L5, with disk desiccation is levels as well as at L1-L2 and T12-L1. The vertebral body and disk heights are otherwise well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the upper L1 level.At T12-L1, there is a very shallow central disk protrusion with annular fissure.At L1-L2, there is a mild disk bulge with right paracentral/foraminal prominence, indenting the ventral thecal sac.At L2-L3, there is a shallow left foraminal disk perfusion which encroaches on the inter-aspect of the foramen. Air trace facet effusions bilaterally.At L3-L4, there is a very shallow central disk protrusion with right paramedian annular fissure. There are trace right greater than left facet effusions.At L4-L5, there is a mild disk bulge with superimposed left paracentral disk protrusion with annular fissure which abuts and slightly posterior displaces the descending left L5 nerve root. There is moderate bilateral facet arthropathy. There is mild left foraminal narrowing.At L5-S1, there is no significant disk pathology or stenosis. | 1. Transitional lumbosacral anatomy at detailed above. If surgery is to be contemplated, correlation with plain films of the entire spine is recommended.2. Mild scattered spondylotic changes as detailed above, without significant right-sided findings. Left paracentral disk protrusion at L4-L5 which closely displaces the descending left L5 nerve root, and also contributes to mild left foraminal narrowing. |
Generate impression based on findings. | 50 year old woman with proven DCIS of the right breast, now presents for ultrasound biopsy for possible invasive component. Right ultrasound re-identified the target lesion for biopsy. The lesion to be targeted are multiple ill-defined hypoechoic masses measuring up to 6 mm at the 9 o’clock position with increased vascularity, 5-6 cm from the nipple. The lesions were 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 right 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 an inferior to superior approach, three 12-gauge core needle (Celero) specimens were obtained of the lesion. Targeting was judged very good. Two specimens sank to the bottom of the prefilled container of 10% formalin. One specimen partially sank. Specimen quality was judged very good.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into the lesion in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incision was closed with a Steri-Strip. Post-procedure digital right CC and ML views revealed the percutaneously placed clip to be in the expected location in the region of scattered calcifications approximately 5 cm from the clip from prior biopsy. No evidence of 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 procedure was performed by Drs. Abe and Patel. Dr. Abe was present during the procedure at all times. | Successful ultrasound-guided core biopsy of right breast lesions and clip placement. Pathology is pending at this time.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Male; 61 years old. Reason: R/o obstruction. Evaluate hydronephrosis, kidney mass History: 61 yo M with L kidney lesion, AKI, hematuria RIGHT KIDNEY: The right kidney measures 11.8 cm in length. The renal cortex is echogenic. No shadowing stone, hydronephrosis, or worrisome renal mass is identified.LEFT KIDNEY: The left kidney measures 11.8 cm in length. The renal cortex is echogenic. Within the mid pole of the kidney is a 1.7 x 1.4 x 2.1 cm exophytic renal cyst with a heavily calcified rim. No shadowing stone, hydronephrosis, or worrisome renal mass is identifiedURINARY BLADDER: The bladder is decompressed by a Foley catheter.OTHER: No significant abnormalities noted. | 1.No hydronephrosis or obstructing renal stone.2.2.1-cm left renal cyst with a heavily calcified rim. No worrisome renal mass. |
Generate impression based on findings. | Male 61 years old; Reason: h/o DLBCL History: re-eval of disease CHEST:LUNGS AND PLEURA: The right upper lobe pulmonary nodule measures 5 mm on image 25/series 5, unchanged. No new lesions have developed. The pleural spaces are clearMEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion no mediastinal lymphadenopathy.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Nonspecific hypodensities in the liver. Gallstones layer within the gallbladder neck.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy.RETROPERITONEUM, LYMPH NODES: Mild calcific arteriosclerotic disease affects the aorta. IVC filter is in place.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostate is enlarged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Small sclerotic foci in the pelvic osseous structures.OTHER: No significant abnormality noted | 1.Stable exam. No significant size change of the right upper lobe pulmonary nodule. |
Generate impression based on findings. | T2N2a right tonsillar squamous cell carcinoma p16+ status post completion of radiation therapy on 10/9/2014. Neck: Redemonstrated are postoperative findings in the right side of the neck, without definite evidence of mass lesions or significant cervical lymphadenopathy. There are bilateral tonsilloliths. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. The bilateral maxillary and mandibular third molars have been extracted. There are mild multilevel cervical degenerative changes. The airways are patent. The imaged portions of the lungs are clear. There is a left chest port.Head: There is no evidence of intracranial mass or abnormal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is minimal mucosal thickening of the left maxillary sinus. The other imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | 1. Postoperative findings in the neck, without definite evidence of residual mass lesions or significant cervical lymphadenopathy.2. No evidence of brain metastases. |
Generate impression based on findings. | 13-year-old male with growth arrest of the left wrist Focal osseous bridging along the ulnar aspect of the distal radial physis as seen on prior exams with resulting Madelung deformity. The remainder of the physes appear patent. The carpal bones appear normal. | Focal osseous bridging along the ulnar aspect of the distal radial physis and resultant Madelung deformity. |
Generate impression based on findings. | Ms. Green is a 49 year old female presenting for a short-term follow-up for calcifications in the left breast. Family history of breast cancer in mother, diagnosed at the age of 59. Three standard views of both breasts with two left spot magnification views 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. There is re-visualization of two separate groups of punctate calcifications in the left lower inner breast, which are stable in appearance and distribution when compared to the prior exam. There is no new mass or areas of architectural distortion identified in either breast. | High probability benign calcifications in the left breast. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended in 6 months to confirm stability of these findings. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months). |
Generate impression based on findings. | Female 71 years old; Reason: h/o HNC and CRT, compare to previous measurements History: none 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: No suspicious hepatic lesions. Hepatic and portal veins are patent. Status post cholecystectomy. NoSPLEEN: No significant abnormality noted.PANCREAS: Age-related fatty atrophy of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes in the stomach from a gastric bypass surgery. No bowel obstruction. Nonspecific colonic wall thickening of the ascending colon with hyperemia suggestive of ongoing colitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomyBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No definite metastatic disease in the chest, abdomen or pelvis.2.Findings suggestive of a colitis. |
Generate impression based on findings. | Seminoma status post chemotherapy and distant history of pulmonary infections, residual masses after chemotherapy. Evaluate for active disease. RADIOPHARMACEUTICAL: 12.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 114 mg/dL. Today's CT portion grossly demonstrates right perihilar enlargement and a right lower lobe pulmonary nodule which appear similar in size to the most recent CT. There is a new trace right pleural effusion. There is a poorly defined hypodense right renal lesion, which is likely a renal cyst. There are scattered subcentimeter retroperitoneal lymph nodes and bilateral inguinal lymph nodes. Today's PET examination demonstrates multiple foci of hypermetabolic activity in the right hilar region corresponding to right hilar enlargement on CT (max SUV of 8.5). There are also hypermetabolic right paratracheal and subcarinal lymph nodes (max SUV of 4.5). A hypermetabolic right lower lobe pulmonary nodule measures a max SUV of 3.0. A linear area of hypermetabolic activity within the right external iliac station (max SUV of 4.5) is equivocal and may represent a lymph node vs post-procedural change. No FDG avid lesion is identified in the neck. | 1. Multiple foci of hypermetabolic activity within the chest including a right perihilar mass, right lower lobe pulmonary nodule, and mediastinal lymph nodes are compatible with metastatic disease.2. Linear area of hypermetabolic activity in the right external iliac station is equivocal and could represent a hypermetabolic lymph node vs post-procedural change.3. New trace right pleural effusion. |
Generate impression based on findings. | Elbow pain, history of gout. Assess for erosions. Evaluation of the elbow is slightly limited due to factors related to portable technique. Given this limitation, see no definite erosions. There there may be elevation of the distal humeral fat pads, suggesting the possibility of a joint effusion, but this is equivocal. | Possible joint effusion, but no definite erosions or other specific radiographic features of gout. |
Generate impression based on findings. | Male, 56 years old, history of laryngeal cancer. On partial imaging of the brain, scattered small hypoattenuating regions are seen within the cerebellum, at least some of which were present on the prior examination and compatible with ischemic lesion.Treatment related findings are redemonstrated on both sides of the neck including numerous scattered surgical clips, volume loss and infiltration of the fascial planes. Evidence of surgery is also seen in the bilateral carotid spaces.The aerodigestive mucosa shows no evidence of mass or pathologic enhancement. Slight asymmetry of the glottic tissues is unchanged and likely relates to therapy. There is a small amount of debris layering posteriorly within the lower trachea.No pathologic adenopathy is detected by size criteria. The major salivary glands and thyroid are free of focal lesions. The right internal carotid artery is occluded at its origin, a new finding when compared to the prior CT neck, but stable when compared to the prior CTA. The left internal jugular vein does not opacify below the level of C1-2. Mild paraseptal emphysema and scarlike opacities are demonstrated in the lung apices.No concerning or destructive osseous lesions are seen. Multilevel cervical spondylosis is redemonstrated similar to prior. | 1. No evidence of local tumor recurrence or pathologic adenopathy in the neck.2. Occlusion of the right internal carotid artery at its origin is new when compared to the prior neck CT, but stable when compared to the prior CTA. |
Generate impression based on findings. | Left knee pain Left total knee arthroplasty device situated in anatomic alignment without radiographic evidence of hardware complication. There is 2 degrees of genu valgum of the left lower extremity.Marked osteoarthritis affects the right knee, as seen on frontal views. | Left TKA without evidence of complication. |
Generate impression based on findings. | Reason: evaluate s/p evd removal History: same The patient is status post right-sided craniotomy for anterior communicating artery aneurysm clip placement. A ventriculostomy tube has been removed. There is some intraventricular blood present which continues to decrease in density. There is no evidence for ventriculomegaly.There is hypodensity present along the anterior aspect of the right temporal lobe as well as the gyrus rectus bilaterally and the a small portion of the medial aspect of the left frontal lobe extending to the cingulate gyrus and superior frontal gyrus. Another hypodense focus is present along the right caudate nucleus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the right maxillary sinus and a frontal sinuses with complete opacification of the left maxillary sinus. There are some air-fluid levels in the sphenoid sinuses and minor opacities in the ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Status post ventriculostomy tube removal. The lateral ventricles are stable and non-enlarged.2.Status-post recent craniotomy for anterior communicating artery aneurysm clip placement.3.Hypodensities along the anterior aspect of the right temporal lobe as well as the inferomedial aspects of the frontal lobes, right caudate nucleus and the medial left frontal lobe are present. One possibility includes that this reflects ischemic insult. This is stable since the prior exam. |
Generate impression based on findings. | There has been significant interval increase in size of the ventricular caliber diffusely, with evidence of periventricular FLAIR hyperintensity consistent with transependymal edema. For example, the third ventricle measures 14-mm transverse as opposed to 7 mm. There is suggestion of elevation of the optic nerve head on the right. There is flattening of the brainstem secondary to the significant fourth ventricular enlargement and associated mass effect.Postoperative changes from previous suboccipital craniectomy for Chiari decompression are again seen, with interval increased dorsal convexity of the neo-foramen magnum likely resulting from the interval surgery. Head position is slightly different on the current exam, although the cerebellar tonsils appear to extended less caudally than on the prior exam, now at the level of the superior margin of the anterior arch of C1, previously at the upper C2 level. Neo-foramen magnum itself appears slightly less crowded with decreased tonsillar tissue extending caudally along the dorsal aspect of the cervical medullary junction.CSF cine flow study demonstrates biphasic CSF flow is present ventrally along the brainstem and the neo-foramen magnum. There is slight improved visualization of flow dorsally to the neo-foramen magnum and along the upper cervical cord. Heterogeneous flow is seen within the syrinx cavity in the upper cervical cord.The suprasellar cistern is partially effaced secondary to the bulging floor of the third ventricle. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures.SPINE | 1. Significant increased caliber of ventricles diffusely with transependymal edema, consistent with acute hydrocephalus. Elevated optic nerve head at least on the right suggested, likely relating to increased intracranial pressure.2. Interval additional postoperative changes from revision Chiari decompression and slight decreased caudal extent of cerebellar tonsils with respect to the neo-foramen magnum although head position is slightly different. Increased CSF flow ventrally along the brainstem and a level of the neo-foramen magnum slight increase position of biphasic flow dorsally.3. Further progression of large expansile syrinx now from upper C2 down to lower T8 level with increased caliber and now essentially filling of the cervical and upper thoracic spinal canal by the expanded cord.EMR indicates that the referring service is already aware of these findings. |
Generate impression based on findings. | Male; 57 years old. Reason: eval pyelonephritis History: UTI, quadriplegic RIGHT KIDNEY: The right kidney measures 8.9 cm in length. The collecting system is mildly dilated with echogenic debris and stones. Secondary infection cannot be excluded. There is no perinephric collection or abscess. Mild hydronephrosis.There is a 7 x 6 x 5 mm simple renal cyst in the mid kidney.LEFT KIDNEY: The left kidney measures 9.5 cm in length. There is minimal hydronephrosis. The renal cortex is normal in echogenicity. There is no shadowing renal stone or worrisome mass.URINARY BLADDER: The bladder is decompressed.OTHER: No significant abnormalities noted. | 1.Mildly dilated right renal collecting system with echogenic debris and stones. Secondary infection cannot be excluded but there is no evidence of abscess.2.Minimal left hydronephrosis. |
Generate impression based on findings. | 58 year old female with pancreatic neuroendocrine tumor metastatic to liver. CHEST:LUNGS AND PLEURA: Mild basilar atelectasis/scarringMEDIASTINUM AND HILA: Calcified hilar lymph nodes likely from prior granulomatous disease.CHEST WALL: Bilateral breast implants.ABDOMEN:LIVER, BILIARY TRACT: Status post partial resection of the right hepatic lobe. Hypervascular lesion in segment 8 (series 7, image 14) measures 9 mm, measured 9 mm previously. Additional previously seen segment 7 and segment 4b lesions are not visualized on this examination which may be due to phase of contrast or treatment effect. No new hepatic lesionsSPLEEN: Status post splenectomy.PANCREAS: Status post distal pancreatectomyADRENAL GLANDS: Unchanged nodular thickening of both adrenal glands.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of stable fluid in Morrison's pouch.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Soft tissue nodule in the right posterior gluteal subcutaneous fat (series 8, image 162) is nonspecific but could be related to injections.OTHER: No significant abnormality noted. | 1.Stable likely metastatic hepatic segment 8 hypervascular lesion. Additional previously seen hypervascular hepatic lesions are not visualized which may be due to phase of contrast or treatment effect. No new lesions. |
Generate impression based on findings. | Reason: lung mass in LLL. compare to outside film in PACS History: cough LUNGS AND PLEURA: Multiple spiculated nodules are seen in the left lower lobe. A nodule in the superior segment of the left lower lobe measures 19 x 16 mm (series 4, image 44), not imaged on comparison CT abdomen pelvis.A pleural based nodule at the medial aspect of the left lung base measures up to 29 x 20 mm (series 4, image 63), not significantly changed from the prior exam.A nodule at the lateral aspect of the left lung base, adjacent to the fissure measures up to 21 x 18 mm (series 4, image 69), not significantly changed from the prior exam.Mild pleural thickening, very small left pleural effusion, and subsegmental atelectasis/scarring at the left lung base.Additional scattered micronodules throughout lungs.MEDIASTINUM AND HILA: The heart is normal in size without significant pericardial effusion. Mild coronary artery calcification.No mediastinal or hilar lymphadenopathy seen within the limitations of noncontrast imaging.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Round, well marginated hepatic hypodensities measure fluid density, unchanged from the prior exam, likely benign cysts. | Three pleural-based nodules in the left lower lobe as described above. The lesions which were visualized on previous CT abdomen and pelvis dated 11/2014 appear stable from that exam. Findings are suspicious for malignancy, including primary lung cancer, versus rounded atelectasis or organizing pneumonia. PET imaging or tissue sampling may be done for further evaluation. |
Generate impression based on findings. | Female 83 years old Reason: 83 yo F with difficulty swallowing, found to have nodularity on EGD bx showing SCC. Pls eval for other intra-abdominal/thoracic involvement or mets History: dysphagia CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Small lymph node in the aorticopulmonary window (series 4, image 35). Calcified mediastinal lymph nodes consistent with prior granulomatous disease. Atherosclerotic calcifications of the thoracic aorta with mild coronary artery calcifications.CHEST WALL: Nonspecific, lucent lesion in the T1 vertebral body without cortical destruction which was not seen on previous MR study. The lesion is best seen on the sagittal view (series 80379, image 54).ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without acute inflammation. Multiple hepatic cysts, unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted. KIDNEYS, URETERS: No significant abnormality noted. Bilateral cortical simple cyst, unchanged and there is an.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Atherosclerotic calcifications of the abdominal aorta and its branches.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Nonspecific lucent lesion in the T1 vertebral body without cortical destruction. 2.No other findings suspicious for metastatic disease. |
Generate impression based on findings. | Reason: evaluate post treatment cancer/HNC History: post CRT HNC CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses.No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. Severe coronary artery calcification. No mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative disease of the thoracic spine. Hemangioma in the T7 vertebral body. Left chest port, tip in the SVC.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: An inferior splenic hypodensity measures 18 x 14 mm (series 3, image 106), slightly increased from the prior exam.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable subcentimeter right renal hypodensity, likely benign cyst.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 disease of the lumbar spine.OTHER: No significant abnormality noted. | 1. No definite evidence of metastatic disease.2. A hypodense lesion at the inferior aspect of the spleen is minimally increased in size from the prior exam. This is unlikely a metastasis in the absence of other metastatic disease and may represent a hemangioma or other benign lesion, but continued follow-up is recommended. |
Generate impression based on findings. | Female 17 years old Reason: evaluate for fracture History: pain along lateral aspect of knee s/p traumaVIEWS: Left knee AP, lateral and oblique 2/17/15 (3 views) Small lateral epiphyseal avulsion fracture of the left tibia along with joint effusion is rising concern for lateral collateral ligament tear and possible medial meniscus and cruciate ligament injury. Knee MR is recommended. | Avulsion fracture of the lateral epiphyses of the left tibia with joint effusion as described. Knee MR is recommended. |
Generate impression based on findings. | Male; 82 years old. Reason: kidney stones History: stones RIGHT KIDNEY: The right kidney measures 11.4 cm in length. The renal cortex is normal in echogenicity. There is minimal hydronephrosis. No shadowing renal stone or worrisome mass is identified. There is an exophytic 3.9 x 3.9 x 4.2 cm minimally complex renal cyst.LEFT KIDNEY: The left kidney measures 11.3 cm in length. The renal cortex is normal in echogenicity. There is minimal hydronephrosis. A nonobstructing 0.6 x 0.5 x 0.3 cm renal stone is seen inferiorly in the kidney. Within the midpole is a 2.3 x 2.2 x 2.2 cm simple renal cyst. No worrisome mass is identified.URINARY BLADDER: The bladder is decompressed.OTHER: 0.8 x 0.8 x 1.2 cm simple cyst in the right lobe of the liver. | 1.Minimal bilateral hydronephrosis.2.Nonobstructing left renal stone. |
Generate impression based on findings. | Swollen left hand. On steroids. Mild soft tissue swelling is present at the dorsum of the hand. No fracture or malalignment is noted. No osseous lesions or erosions are noted. | Soft tissue swelling, without abnormality otherwise evident. |
Generate impression based on findings. | 38 years old female with a history of T cell Rich B Cell Lymphoma with associated HLH s/p 6 cycles of R CHOEP in need of end of treatment staging. Please compare to prior. RADIOPHARMACEUTICAL: 12.8 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 100 mg/dL. Today's CT portion of the neck demonstrates no significant pathology. Please see diagnostic CT reports for details of the chest, abdomen, and pelvis.Today's PET examination demonstrates mild to moderate increase of FDG uptake in the right common iliac, right obturator and right external iliac lymphadenopathy as well as in the lymphadenopathy in the right inguinal region. SUVmax in the enlarged right obturator lymph nodes is 6.8. There is also increased FDG uptake in the enlarged lymph nodes in the left inguinal region with SUV Max of 5.5.Minimal FDG uptake is seen in the multiple small lymph nodes in the retroperitoneal cavity, which is consistent with post-therapy change. There is minimal FDG uptake in a cystic lesion in the right pelvis attached to the uterus.Symmetrical areas of FDG uptake in the neck are consistent with brown fat and muscle activity.Physiological activity is seen in the liver, spleen, kidneys, intestines and bladder. | 1.Hypermetabolic lymph nodes in the right side of pelvis and the bilateral inguinal regions, which are consistent with the metabolically active tumor.2.Minimal FDG uptake seen in the cystic lesion attached to the uterus in the right side of the pelvis, which is most likely due to a functional ovarian cyst.Diagnostic CTs of the chest, abdomen, and pelvis also performed at today's visit will be reported separately. |
Generate impression based on findings. | The bilateral hippocampi are symmetric. There is no evidence of cortical dysplasia or gray matter heterotopia. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal. Areas of peritrigonal hyperintensity relate to normal terminal zones of myelination. There is no diffusion abnormality. No extra-axial fluid collection is identified. There is moderate mucosal thickening of the bilateral ethmoid and maxillary sinuses.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. | No evidence of seizure focus. |
Generate impression based on findings. | Back pain The alignment is anatomic. There is mild narrowing of the L5-S1 disk space, likely degenerative. The vertebral body heights and disk spaces are otherwise preserved. No fracture or spondylolisthesis is evident. The sacroiliac joints are normal in appearance. | Mild degenerative disk disease at L5-S1. |
Generate impression based on findings. | Ms. Oken is a 47 year old female with a personal history of right breast mastectomy in October 2012 for IDC/DCIS followed by implant based reconstruction in February 2013. She has no current breast related complaints. Two full field views and two implant displaced views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Silicone implant is intact. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the left breast. Benign appearing lymph nodes are projected over the left axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Myeloma. Recurrent lower back pain SKULL: No significant abnormality noted. No discrete myelomatous lesions evident. Tiny lucencies likely represent venous lakes.CERVICAL SPINE: Anterior fusion of C4 through C7, with degenerative changes. No discrete myelomatous lesions evident. THORACIC SPINE: Mild to moderate multilevel degenerative changes. No discrete myelomatous lesions evident. LUMBAR SPINE: Six lumbar-type vertebral bodies are noted. The lower-most vertebral body is referred to as L6, which demonstrates sacralization. Fusion of C4-C5 is noted. Mild degenerative changes are present. No discrete myelomatous lesions are evident. RIBS: No significant abnormality noted. No discrete myelomatous lesions evident. Left upper extremity port tip at the SVC/RA junction.PELVIS: Evaluation of the upper pelvis is limited by overlying bowel gas and stool. The bones are mildly demineralized, indicating osteopenia. No discrete myelomatous lesions evident. UPPER EXTREMITY: No significant abnormality noted. No discrete myelomatous lesions evident. LOWER EXTREMITY: No significant abnormality noted. No discrete myelomatous lesions evident. | No discrete myelomatous lesions evident. Additional findings, as above. |
Generate impression based on findings. | 80 year-old female with history of altered mental status. There is no evidence of acute intracranial hemorrhage. There is an area of encephalomalacia within the left superior frontal lobe compatible with chronic infarction. An additional area of encephalomalacia is observed within the right anterior temporal lobe with associated ex vacuo dilatation of the temporal horn of the right lateral ventricle. There is extensive periventricular and subcortical white matter hypoattenuation compatible with age indeterminate small vessel ischemic disease. Foci of hypoattenuation within the left basal ganglia likely represent small lacunar infarcts. The ventricles and sulci are symmetric. The basal cisterns are intact. The visualized paranasal sinuses, mastoid air cells and orbits are unremarkable. The calvarium and soft tissues of the scalp are within normal limits. | 1. Chronic infarctions of the right anterior temporal and left superior frontal lobes.2. Extensive age indeterminate small vessel ischemic disease and chronic left basal ganglia lacunar infarcts.3. CT is insensitive for the detection of acute ischemia. If patient care warrants further imaging, an MRI may be obtained. |
Generate impression based on findings. | 10-month old female, evaluate for hip dysplasiaVIEWS: Pelvis, AP (one view) 2/17/15 9:45 Both normal appearing femoral heads are well directed within the well formed acetabula. | Normal examination. |
Generate impression based on findings. | Abdominal pain; metastatic prostate carcinoma ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Accounting for differences in technique comment no significant change in extensive confluent bilobar hepatic metastases.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No change in ventral hernia with bowel involvement. No change in peristomal hernia with bowel involvement. No evidence for associated bowel obstruction or bowel wall edema.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No change in soft tissue mass within the prosthetic bed.BLADDER: Unremarkable ileal conduit.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Stable L2 vertebral body sclerotic focus.OTHER: No significant abnormality noted | Stable examination. No change in confluent extensive bilobar hepatic metastatic disease. No change in small peristomal hernia or ventral hernia without evidence for bowel obstruction or bowel wall edema. |
Generate impression based on findings. | Metastatic colon cancer surveillance after chemotherapy. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Multiple metastatic lesions are again seen throughout the liver. While the reference liver lesion (segment 5, series 4, image 49) has not significantly changed and measures 1.8 x 1 .6 cm, previously 1.9 x 1 .8 cm, many other lesions are smaller in size and fewer lesions are seen. For example the lesion in segment 4 (series 4, image 35) now measures 1.2 x 1 .0 cm, where 11/23/14 this measured 2.0 x 2.1 cm. Gallbladder and biliary tract appear normal. New ascites about the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneum lymph nodes are again seen, but have slightly decreased in size. The reference to left periaortic lymph node (series 4, image 46) measures 1.0 x 0.9, previously 1.2 x 1.1 cm. No new foci of lymph node enlargement is seen.BOWEL, MESENTERY: Stomach and small bowel show no significant abnormalities. Contrast reaches the right colon without obstruction. Ascending colon, transverse colon are filled with fecal material with a stent now seen beginning in the splenic flexure and extending inferiorly across the previous noted tumor. Tumor extending into the adjacent soft tissues is again seen medially (series 4 commonly 61) within measurable mass measuring 1.9 x 1 .8 cm, previously measuring 2.6 x 2.1 cm. Adjacent small scattered lymph nodes are again seen medial to the colon. Minimal ascites is now seen limited to about the liver but not free elsewhere in the abdomen.Although tumor burden elsewhere appears to have decreased, there is new infiltration in a linear, latticelike appearance in the right anterior omentum (series 4, image 62) which is worrisome for early presentation of omental disease. Further follow-up imaging could clarify this.BONES, SOFT TISSUES: Degenerative skeletal changes in lumbar spine again seen.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 changes about the pelvis similar to prior with right hip arthroplasty device again seen unchanged.OTHER: No significant abnormality noted | 1. Interval insertion of colonic stent across descending colon tumor. Slightly decreased size of tumor mass extending into medial mesentery. 2. Although the reference lesion has changed only minimally, there has been a reduction in the number and size of multiple other metastatic lesions in the liver. 3. Borderline enlarged lymph nodes seen in periaortic region slightly decreased in no change in the subcentimeter small lymph nodes adjacent to descending colon tumor. 4. New ascites (small amount) about the liver. 5. Nonspecific linear infiltration in the right anterior omentum, worrisome for early omental metastasis but may relate to infiltration from nearby ascites. |
Generate impression based on findings. | Question of hot or cold nodules. There are multiple hypofunctioning small nodules within the right thyroid lobe in the lower, mid-, and upper poles. There is a medium to large dominant warm nodule within the left lower pole and a medium-sized hyperfunctioning nodule within the left mid-pole. A medium sized hypofunctioning nodule is also seen within the most inferior aspect of the left thyroid lobe. The 4-hour radioactive iodine uptake is 8% and the 24-hour uptake is 28% (normal range 10-30% at 24-hours). | 1. Multiple hypo- to hyperfunctioning nodules with a normal uptake is suggestive of multinodular goiter. 2. Bilateral hypofunctioning nodules are indeterminate; correlate with ultrasound/biopsy is as clinically indicated. |
Generate impression based on findings. | Female 53 years old Reason: pain History: pain. Three views of the left ankle show a mild deformity of the left fibula, likely representing an old fracture. Ossification along the distal aspect of the medial malleolus likely reflects old trauma, but we see no acute fracture. A small round lucency in the medial aspect of the talar dome may represent a subchondral cyst or old osteochondral defect. Mild osteoarthritis affects the midfoot.We have 3 views of the right ankle which show mild to moderate osteoarthritis of the midfoot. | Old posttraumatic and osteoarthritic changes as described above. |
Generate impression based on findings. | 65-year-old male with colonic mass at 55 cm from anal verge, evaluate for any metastatic disease. CHEST:LUNGS AND PLEURA: Parenchymal lung nodules or masses. No airspace disease or pleural disease.MEDIASTINUM AND HILA: No adenopathy or other abnormality.CHEST WALL: Degenerative changes throughout the thoracic spine to a mild degree. No other significant abnormality seen.ABDOMEN:LIVER, BILIARY TRACT: Hypoattenuating but Stallings lesions are seen throughout both lobes of the liver consistent with metastatic disease. Two reference lesions or provide in:1. Right hepatic dome (series 3, Image 71) measures 1.6 x 1.9 cm.2. Segment 5 laterally (series 3, image 88) measures 1.8 x 1.3.Scattered low near water attenuation subcentimeter lesions are seen representing benign cysts in multiple locations.Hepatic vessels appears normal. Gallbladder and biliary tract appear normal.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonobstructing punctate right renal calculus. Right kidney otherwise is normal in appearance. Atrophic left kidney with benign appearing cyst in midpole. No other abnormalities.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Oral contrast has emptied through the stomach which is collapsed. The small bowel is well opacified and shows no evidence of obstruction or intrinsic abnormality. Contrast does reach the cecum which is filled with fecal material. Feces is seen throughout the colon. Two areas of apparent focal thickening of the colon wall are seen, the most proximal in the proximal transverse colon (series 3 cow image 107) and a second focus of circumferential thickening in the sigmoid colon (series 3 , image 159). 55 cm would most likely represent the sigmoid lesion. The transverse colon lesion remains suspicious as well for cancer although an unprepped colon with contractions and spasm can simulate mass lesions.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate with calcifications in the seminal vesicles without other significant abnormality noted.BLADDER: No significant abnormality notedLYMPH NODES: Multiple surgical clips seen in the left external iliac region. No enlarged lymph nodes identified.BOWEL, MESENTERY: The small bowel is well opacified and shows no evidence of obstruction or intrinsic abnormality. Contrast does reach the cecum which is filled with fecal material. Feces is seen throughout the colon. Two areas of apparent focal thickening of the colon wall are seen, the most proximal in the proximal transverse colon (series 3 cow image 107) and a second focus of circumferential thickening in the sigmoid colon (series 3 , image 159). 55 cm would most likely represent the sigmoid lesion. The transverse colon lesion remains suspicious as well for cancer although an unprepped colon with contractions and spasm can simulate mass lesions. No free mesenteric fluid.BONES, SOFT TISSUES: Anterior umbilical hernia containing only mesenteric fat. Degenerative changes throughout the lumbar spine. OTHER: No significant abnormality notedd | 1. Two foci of circumferential colonic wall thickening (proximal transverse colon and sigmoid colon). The colon was not prepped for detailed examination and these two lesions may represent significant lesions or be artifactual. 2. Multiple solid liver lesions most consistent with metastatic lesions with reference measurements provided above. 3. Atrophic left kidney. |
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