instruction stringclasses 1 value | input stringlengths 6 8.98k | output stringlengths 5 3.11k |
|---|---|---|
Generate impression based on findings. | Male, 12 years old, with Dandy-Walker malformation, VP shunt with revisions. Now with headache. The right parietal approach ventricular shunt catheter is in stable position with its tip situated approximately at the level of the left frontal horn. The visualized portions of the catheter system are intact. The size and morphology the ventricular system shows no significant interval change with near complete collapse of the left lateral ventricle.A retrocerebellar fluid filled space is unchanged in size morphology. Mild deformation of the cerebellar vermis and hemispheres is also unchanged.Elsewhere in the brain, no loss of gray-white distinction, edema or mass effect is detected. No intracranial hemorrhage or any new abnormal extra axial fluid collection is detected.The osseous structures of the skull are intact. The visualized paranasal sinuses are clear. There is partial opacification of the mastoid air cells. The adenoids are prominent. | No change in the appearance of the shunted ventricular system and no evidence of any acute intracranial abnormality. |
Generate impression based on findings. | Pain at medial aspect of wrist. No fracture or malalignment. Mild degenerative changes are present at the basilar joint. No significant abnormality otherwise noted. | No specific findings to account for the patient's pain. |
Generate impression based on findings. | The ventricles and sulci are prominent, consistent with mild age-related volume loss. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are scattered punctate areas of abnormal low attenuation in the periventricular and subcortical white matter, consistent with stable minimal chronic small vessel ischemic changes. There are chronic lacunar infarcts in the right caudate head and right basal ganglia. There is no extraaxial fluid collection. There are extensive intracranial vascular calcifications of the cavernous carotid, basilar and vertebral arteries. There is minimal mucosal thickening of the bilateral maxillary sinuses. The remainder of the visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. There are bilateral lens implants. | 1. No acute intracranial hemorrhage. 2. Chronic lacunar infarcts in the right caudate head and right basal ganglia. Stable minimal chronic small vessel ischemic changes. Please note that CT is insensitive for the detection of acute nonhemorrhagic ischemic event. |
Generate impression based on findings. | 23-year-old female with abdominal pain. Evaluate for obstruction.VIEW: Abdomen AP (one view) 2/17/2015 10:31 Six coils are again seen in the right lower quadrant.Nonobstructive bowel gas pattern. Visualized lung bases are normal. | No evidence of obstruction. |
Generate impression based on findings. | Ms. Durtineeviciute is a 41 year old female with a strong family history of breast cancer in maternal cousin, ovarian cancer in mother and cervical cancer in maternal grandmother. Positive for BRCA 1. Three standard views of both breasts with two left spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. Focal asymmetry in the left central breast disperses into normal breast parenchyma on spot compression views. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Patients with BRCA positive gene mutations should also strongly consider annual MRI as an additional surveillance tool. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Left arm/leg paresthesias and subtle left sided pronator drift. There is no appreciable change in the patchy cerebral white matter hypoattenuation and more focal encephalomalacia in the left occipital lobe and basal ganglia. There is no evidence of acute intracranial hemorrhage or mass. There are bilateral carotid siphon vascular calcifications. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | No appreciable change in the small vessel ischemic disease and chronic left occipital lobe and basal ganglia infarcts, but no evidence of acute intracranial hemorrhage. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct and MRI is recommended for further evaluation. |
Generate impression based on findings. | right CCA stenosis slightly worse on USG comparing to 6 months ago. NONCONTRAST CT HEADNo evidence of acute ischemic or hemorrhagic lesion on this scan.Calcified and small eye globe on the left.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. CTA HEAD AND NECKThe right proximal extracranial ICA shows about 44% luminal stenosis based on NASCET method (narrowed luminal diameter is 3.5mm and distal normal ICA diameter is 6.2mm) with wall calcification.Aortic arch and major aortic arch branches appear to be normal without significant luminal stenosis but with wall calcifications indicating atherosclerotic changes.The bilateral vertebral artery origins appear to be normal, the right vertebral artery is hypoplastic.Bilateral common carotid arteries show wall calcifications and luminal irregularity but without showing significant luminal stenosis.The right ICA just above the bifurcation shows 44% of luminal stenosis with wall calcificaitons as described above.There is also about 4mm sized wide neck right ACA A1-A2 junctional aneurysm pointing medially. The left PCA is fetal origin and the left Pcom and Acom artery are patent.Intracranial circulations are otherwise unremarkable except non-significant luminal narrowings and irregularities indicating atherosclerotic changes.There is normal superficial and deep intracranial venous drainage. | 1. About 44% luminal narrowing based on NASCET method with wall calcifications on the right extracranial ICA just above the bifurcation.2. About 4mm sized wide neck right A1-A2 junctional aneurysm.3. Atherosclerotic changes of intracranial and extracranial arterial system as described above.4. No evidence of acute ischemic or hemorrhagic lesion. |
Generate impression based on findings. | Evaluation is limited by lack of intravenous contrast and by motion artifact.PHARYNX/LARYNX: The nasopharynx, oropharynx, hypopharynx, and larynx are unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass.GLANDS: The submandibular, sublingual, and parotid glands have an unremarkable noncontrast appearance. The thyroid gland is unremarkable. ORAL CAVITY: The oral tongue and floor of mouth are unremarkable. There is carious disease of multiple teeth as well as multiple missing teeth.CERVICAL SOFT TISSUES: Scattered small cervical lymph nodes are identified.OTHER: Deviation of the trachea at the level of the thyroid gland towards the left. Mild mucosal thickening of the bilateral maxillary sinuses. Torus palatini. Straightening of the cervical lordosis. Minimal anterolisthesis of C3 on C4 and C4 on C5 with central disc protrusion at these levels, effacing the ventral thecal sac and mild flattening of the ventral cord. Advanced atherosclerotic calcifications of the intracranial and extracranial vessels. Bilateral lens implants. Dual lead left hemithoracic pacer/AICD device. Trace bilateral pleural effusions. Subcentimeter right upper lobe partially calcified granuloma. Please refer to the separate chest CT report of 11/30/2014 for additional details. | 1. Evaluation is limited by lack of intravenous contrast and by motion artifact. Within these limitations, there is no significant abnormality of the neck soft tissues.2. Multiple dental caries and absent teeth. |
Generate impression based on findings. | 64 years, Male, Reason: pelvic GIST on gleevac - restaging History: re-staging. does ok w/ MRI contrast. PELVIS: MalePROSTATE, SEMINAL VESICLES: Posterior margin of the prostate is indistinguishable by adjacent tumor, unchangedBLADDER: No significant abnormality noted.LYMPH NODES: Small bilateral inguinal lymph nodes are unchanged. No new lymphadenopathy.BOWEL, MESENTERY: A necrotic tumor in the retrovesicular space is unchanged in size measuring 8.0 x 5.0 x 8.1 cm (7/23, 7/22, 8/18), previously 8.2 x 5.0 x 8.2 cm. A thick rind of peripheral mildly enhancing tissue with increased T1 signal and an enhancing nodule along the inferior aspect the tumor are stable. There is adjacent invasion of the prostate, rectum and pelvic floor appearing similar to the prior exam.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Pelvic gastrointestinal stromal tumor is stable. No evidence of metastasis. |
Generate impression based on findings. | 56 year-old female. Shortness of breath, new oxygen requirement. History of lung cancer and laryngeal cancer. LUNGS AND PLEURA: Interval resolution of small right pleural effusion.Dense right paramediastinal consolidation with new small nodular opacities in the right upper lobe, consistent with post-radiation change and obscuring the right lower lobe mass.Stable post surgical findings a right upper lobe wedge resection.Small intraluminal tracheal debris. New patchy basilar predominant opacities consistent with aspiration and/or atelectasis. Associated left lower lobe bronchial wall thickening and scattered mucus plugging.No suspicious pulmonary nodules identified.Very mild emphysema.MEDIASTINUM AND HILA: Post-surgical findings of laryngectomy and flap construction with tracheostomy and voice prosthesis.Right hilar lymphadenopathy, not significantly changed. Reference lymph node posterior to the right pulmonary artery is 11 mm (series 3, image 36), unchanged.Patulous thoracic esophagus containing debris.CHEST WALL: Unchanged left subcentimeter subpectoral lymph nodes. UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Bibasilar patchy opacities with associated bronchial wall thickening consistent with aspiration and/or infection. Dense right paramediastinal consolidation with new small nodular opacities in the right upper lobe, consistent with post-radiation change and obscuring the right lower lobe mass. |
Generate impression based on findings. | Clinical question: Evaluate for hemorrhage. Signs and symptoms: Status post ablation of hippocampus. Nonenhanced head CT:Cerebellar tonsillar herniation through the foramen magnum with resultant complete effacement of subarachnoid space remains similar to prior exams and consistent with Chiari malformation.Focus of low attenuation extends from the medial aspect of right temporal lobe posteriorly along the medial aspect of right anterior and mid temporal lobe and increased size as it reaches the posterior aspect of right temporal medially. Findings are suggestive of edema as result of ablation of hippocampus. There is no significant detectable mass effect with this finding. There is no evidence of hemorrhage. Ventricular system remains within normal size and maintain midline.There is a right anterior temporal -- frontal burr hole as well as a right posterior parietal burr hole present. | 1.A band of edema extending along the medial aspect of the right anterior, mid and posterior temporal lobe without hemorrhage or appreciable mass effect.2.Herniation of cerebellar tonsils through the foramen magnum and unremarkable exam otherwise.3.Right anterior temporal and right posterior parietal bur holes are noted. |
Generate impression based on findings. | Hyperthyroidism, please evaluate for autonomous nodule versus thyroiditis. There is a dominant large warm to hyperfunctioning nodule within the right lower pole/isthmus without significant suppression of uptake throughout the remaining thyroid gland. There are multiple small to medium sized iso to warm and hypofunctioning nodules with both thyroid lobes. There is a medium sized hypofunctioning nodule within the left lower pole. The 5-hour radioactive iodine uptake is 14% and the 24-hour uptake is 26% (normal range 10-30% at 24-hours). | 1. Multinodular thyroid with a predominant warm to hyperfunctioning right lower pole/isthmus nodule with overall normal thyroid uptake.2. Medium-sized left lower pole hypofunctioning nodule is indeterminate; correlate with ultrasound/biopsy as clinically indicated. |
Generate impression based on findings. | Follow-up fifth metatarsal stress fracture. Again seen is a fracture of the proximal diaphysis of the fifth metatarsal. The fracture fragments are in anatomic alignment. Callus formation along the fracture compatible with healing it is slightly progressed. | Healing fifth metatarsal stress fracture. |
Generate impression based on findings. | Female 67 years old Reason: hx Post cervical fusion, eval hardware placement, bony fusion and stability History: surveillance imaging. Again seen is an anterior plate with screws entering the C3 and C7 vertebrae, appearing similar to the prior study. There is fusion of the C3 through C6 vertebral bodies, appearing similar to that seen on the prior study. Posterior rods with screws entering C5, C6, T1, and T2 appear similar to the prior study. There is mild degenerative disk disease at C6/C7. There is a grade 1 anterolisthesis of C7 which appears stable between the flexion, neutral, and extension views. The neuroforamina of the upper spine appear slightly narrowed, particularly on the right, but this may, in part, be an artifact of obliquity of positioning. The lower cervical foramina are obscured by overlying hardware. | Postoperative changes of spinal fusion appearing similar to the prior study without frank instability. |
Generate impression based on findings. | Female 21 years old Reason: is there . a fracture of fibula? History: pain after injury We have 3 views of the right ankle which show mild soft tissue swelling of the right lateral ankle, as well as a small tibiotalar joint effusion. There is a subcentimeter ossicle distal to the fibular tip which appears corticated and, hence, may represent prior trauma; we suspect it does not represent acute fracture.We have 3 views of the right foot which show no acute fracture. Note is made of a type I accessory navicular bone. | Ossicle distal to the fibular tip, which we suspect is chronic in etiology. There is soft tissue swelling and a small tibiotalar effusion, but we see no acute fracture. |
Generate impression based on findings. | 69-year-old female with history of thoracic and abdominal aortic aneurysms. CT ANGIOGRAM: Postoperative changes are seen about the ascending aorta which maintains a stable diameter of approximately 3.5 cm (series 7, image 269). There are postoperative changes of the aortic arch which appear similar to the prior exam without new aneurysmal dilatation. The fusiform aneurysm of the distal thoracic and upper abdominal aorta are again seen which appears similar to prior. The lower thoracic aneurysm measures 5.0 x 6.4 cm (series 7, image 464), measured 5.0 x 6.4 cm previously. The previously noted proximal left subclavian artery aneurysm has been repaired with normal caliber.Just below the diaphragmatic hiatus but above the renal arteries, the upper abdominal component of the fusiform aneurysm (series 7, image 63 6) measures 5.0 x 5.2, previously 5.1 x 5.2 cm. Peripheral mural thrombotic plaque is seen dorsally, similar to prior. Infrarenal abdominal -- biiliac endovascular stent is again seen. The stent is patent with a similar appearance. AP diameter of the aortic surrounding sac measures 4.8 cm, previously 4.7 cm, not significantly changed. No evidence of endovascular leak is seen in the aneurysmal sac. Bilateral common iliac arteries bifurcate normally into the internal and external iliac arteries with normal peripheral distribution.Origin of the celiac axis and peripheral distribution of its branches are normal. Mild narrowing of the superior mesenteric artery is again seen with focal dissection in the more distal superior mesenteric artery similar to prior studies. Saccular aneurysms off the origin of both right and left external arteries are again seen subcentimeter in size bilaterally.CHEST:LUNGS AND PLEURA: Left basilar atelectasis, new from prior. No suspicious nodules or masses.MEDIASTINUM AND HILA: Moderate coronary artery calcifications. Nonspecific small mediastinal lymph nodes.CHEST WALL: Sternotomy changes. ABDOMEN:LIVER, BILIARY TRACT: Vicariously excreted contrast in the gallbladder.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted. KIDNEYS, URETERS: Subcentimeter low attenuation renal lesions too small to characterize.RETROPERITONEUM, LYMPH NODES: Scattered prominent retrocrural, pericaval and periaortic lymph nodes are again seen unchanged in size or appearance.BOWEL, MESENTERY: Anterior abdominal wall umbilical ventral hernia containing only mesenteric fat. Normal caliber bowel without evidence of obstruction.BONES, SOFT TISSUES: Diffuse degenerative changes without focal abnormality otherwise seen.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: Anterior abdominal wall umbilical ventral hernia containing only mesenteric fat. Normal caliber bowel without evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Stable appearance of repaired aortic arch, distal aortic fusiform aneurysm, and proximal abdominal aortic aneurysm.2.Stable appearance of abdominal aortic aneurysm with aortobiiliac endovascular graft without evidence of endovascular leak.3.Stable bilateral saccular aneurysms at the origins bilateral renal arteries.4.New left basilar atelectasis. |
Generate impression based on findings. | Limited upper GI examination was performed to evaluate for leak. Single contrast evaluation of the stomach was performed. The gastric body was decompressed and remained nondistended throughout the study. The examination was limited by patient's limited mobility which precluded the acquisition of lateral images. Within this limitation, AP and oblique images did not demonstrate any extravasation of contrast outside of the stomach contour. Contrast passed into the duodenum and proximal jejunum. | Limited study due to patient immobility. Within this limitation no evidence of gastric leak. |
Generate impression based on findings. | 14-year-old male with fracture.VIEWS: Right ankle AP, oblique, lateral (3 views) 2/17/2015 10:56 Stable positioning of distal tibial epiphyseal screws with no evidence of hardware complications. Healing triplane tibial fracture in anatomic alignment. | Healing fracture in anatomic alignment, with no evidence of hardware complications. |
Generate impression based on findings. | 59-year-old male. Five years out from RUL cancer. Pre-op CT. CHEST:LUNGS AND PLEURA: Stable postsurgical changes of right upper lobe wedge resection. Again seen is a 16 x 16 mm right upper lobe nodule adjacent to the suture line (series 4, image 44), unchanged and highly suspicious for recurrent tumor.Previously seen subpleural right middle lobe scar like opacity has resolved.Unchanged small focus of ground glass opacity in the right lung base (series 4, image 78), which may represent focal scarring.MEDIASTINUM AND HILA: Prominent mediastinal lymph nodes, increased in size from prior, nonspecific. No hilar lymphadenopathy.Normal heart size without pericardial effusion.Moderate coronary artery calcification.CHEST WALL: Median sternotomy.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable hepatic dome hypodensity, most likely a cyst. No suspicious hepatic lesion. Cholecystectomy clips.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 disease of the abdominal aorta. Small gastrohepatic ligament lymph nodes, unchanged.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. | Unchanged right upper lobe nodule adjacent to surgical suture highly suspicious for recurrent tumor. Prominent mediastinal lymph nodes, increased in size from prior, nonspecific. |
Generate impression based on findings. | 28 years, Male. Reason: kidney stone History: stone Lung bases are clear. Average stool burden. Nonobstructive bowel gas pattern. Radiodense opacity overlies the left kidney. | Radiodense opacity overlies the left kidney. |
Generate impression based on findings. | Bilateral knee pain Severe osteoarthritis affects the knees bilaterally, left greater than right, with tricompartmental joint space narrowing and osteophytes. There is bone on bone apposition at the medial compartments of the knees bilaterally. No joint effusion is evident in either knee. | Severe osteoarthritis, as above. |
Generate impression based on findings. | 69 year-old female with metastatic ovarian cancer CHEST:LUNGS AND PLEURA: Scattered and nonspecific micronodules in both lungs unchanged since 12/1/14. Largest nodule measures 5 mm (series 5, image 56).MEDIASTINUM AND HILA: No adenopathy. Cardiac wires unchanged and no pericardial effusion.CHEST WALL: Degenerative changes about the thoracic spine without focal abnormality otherwise seen. Right internal chest wall Port-A-Cath with expected position catheter tip at the cavoatrial junction.ABDOMEN: Within the limits of a non-IV contrast enhanced examination is limited ability to evaluate solid parenchymal organs and vascular structures, the following observations can be made:LIVER, BILIARY TRACT: Although no abnormalities noted within the liver parenchyma, lack of IV contrast markedly limits ability of CT to detect liver lesions. There is focal thickening posteriorly about the liver capsule (axial series 4, image 77 and coronal series image 42) that suggests surface metastatic lesion along the liver, although lack of IV contrast makes this not a definitive diagnosis.Gallbladder and biliary tract appear normal.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Moderately extensive para-aortic adenopathy is seen throughout the retroperitoneum. Lack of IV contrast makes these difficult to delineate as separate from the inferior vena cava and aorta. Reference measurement (series 4, image 115) measures 2.2 x 2.5 cm -- this measured 1.8 x 2.8 cm on 12/1/14 CT examination. Second periaortic lymph node more cephalad (series 4 , image 98) measures 1.5 x 1 .7 cm, previously measuring 1.0 x 1.4 cm.BOWEL, MESENTERY: Moderate-sized hiatal hernia is seen with the otherwise collapsed stomach and duodenum shows a large duodenal diverticulum extending medially and remainder of small bowel appears intrinsically normal, although there is a large right anterior pelvic wall hernia containing small bowel without complication. Colon is normal in appearance filled with fecal material. No free mesenteric fluid is identified. No mesenteric abnormal masses seen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Prior hysterectomy without other abnormality seen.BLADDER: No significant abnormality noted.LYMPH NODES: Above-noted retroperitoneal lymphadenopathy extends into the bilateral common iliac chain and right and left external iliac chain (greater on the right iliac chain). Reference measurement (series 4, image 150) shows a right external iliac lymph node measuring 1.6 x 2 .2 cm, measuring 1.6 x 2.0 cm on 12/1/14.Enlarged left inguinal lymph nodes are seen. Reference lymph node (series 4, image 161) measures 1.8 x 1 .6 cm, measuring 1.7 x 1.4 cm in process 1/14.BOWEL, MESENTERY: small bowel appears intrinsically normal, although there is a large right anterior pelvic wall hernia containing small bowel without complication. Colon is normal in appearance filled with fecal material no free mesenteric fluid is identified. No mesenteric abnormal masses seen.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Nonspecific pulmonary micronodules unchanged since/1/14 examination. 2. Moderately Extensive para-aortic and pelvic iliac adenopathy with slight increase in size since 12/1/14. 3. Probable posterior hepatic capsule surface soft tissue metastastic seeding. 4. Large right pelvic anterior wall hernia containing small bowel without complication. |
Generate impression based on findings. | There is redemonstration of a masslike area of hyperdensity within the premedullary cistern, consistent with subarachnoid blood products. A minimal amount is noted dorsal to the caudal medulla, unchanged. There is associated mass-effect upon the caudal aspect of the medulla. There is a stable right frontal approach ventriculostomy catheter with tip near the right foramen of Monro. Dilated ventricular caliber appears similar, with the third ventricle measuring 1.2 to 1.3 cm transverse. Trace hyperdensity is noted within the occipital horns.There are persistent scattered areas of abnormal low density within the left greater than right mid to inferior frontal lobe parenchyma as well as involving the left temporal gyrus. There is associated mild ex vacuo dilatation of the left lateral ventricle.There is redemonstration of a radiopaque distal left internal carotid artery stent. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | 1. Stable appearance of subarachnoid hemorrhage predominantly collecting in the premedullary cistern and minimally along the dorsal aspect of the medulla with mild mass-effect.2 Stable ventriculostomy catheter with unchanged ventriculomegaly.3. Stable scattered areas of encephalomalacia. |
Generate impression based on findings. | Male 58 years old Reason: restaging scans s/p 3 weeks of investigational immunotherapy; please assess extent of metastatic disease compared to previous scans History: hx of metastatic bladder cancer CHEST:LUNGS AND PLEURA: No focal consolidation or pleural effusion. No suspicious nodules or masses.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Previously seen enlarged supraclavicular have resolved with reference left supraclavicular measuring 0.8 x 0.8 cm, previously 1.9 x 1.2 cm (series 4, image 4). Resolution of previously seen enlarged mediastinal nodes with reference left paratracheal node measuring 0.8 x 0.7 cm, previously 1.8 x 1.1 cm (series 4, image 13). Heart size is normal without pericardial effusion.CHEST WALL: No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Interval decrease in size of the enlarged retroperitoneal nodes with a reference periaortic node measuring 2.1 x 1.0 cm, previously 2.2 x 1.5 cm (series 4, image 114).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Postsurgical changes of cystoprostatectomyBLADDER: Postsurgical changes of cystoprostatectomy with right lower quadrant ileal conduitLYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mild degenerative changes of the visualized spine. OTHER: No significant abnormality noted | 1.Interval resolution of supraclavicular and mediastinal lymphadenopathy with decrease in size of the retroperitoneal lymphadenopathy.2.No new metastatic disease. |
Generate impression based on findings. | 70 year-old female history of soft palate clear-cell carcinoma status post resection. Extensive streak artifact from dental amalgam limits evaluation of the oral tongue and palate. There is no evidence of cervical lymphadenopathy by CT size criteria. The salivary glands are unremarkable. There is a new 4 mm hypoattenuating focus within the right thyroid lobe which is nonspecific. The airway is intact. The visualized intracranial structures and paranasal sinuses are clear. There is asymmetric opacification of the left mastoid air cells. The vasculature is intact. There is moderate multilevel degenerative disease. | 1. Limited study due to streak artifact limits evaluation of the palate.2. No evidence of cervical lymphadenopathy.3. New 4mm hypoattenuating lesion within the right thyroid lobe is nonspecific. If patient care warrants further imaging, a dedicated ultrasound may be obtained. |
Generate impression based on findings. | Female 35 years old Reason: instability? History: LBP. Small osteophytes project from the anterior aspect of the lumbar vertebrae. Vertebral body heights and intervertebral disk spaces appear normal. Alignment is within normal limits and we see no spondylolisthesis or instability between the flexion, neutral, and extension views.There is perhaps mild facet joint osteoarthritis affecting the lower lumber spine. Surgical clips in the right upper quadrant are likely from a prior cholecystectomy. | Minimal degenerative arthritic changes without evidence of instability. |
Generate impression based on findings. | PHARYNX/LARYNX: There are stable post-treatment changes in the left oropharyngeal region. 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 stable, with diminutive size of the submandibular glands likely posttreatment related. The thyroid gland is unremarkable. ORAL CAVITY: The oral tongue and floor of mouth are unremarkable.CERVICAL SOFT TISSUES: There are no pathologically enlarged cervical lymph nodes.OTHER: There is a retropharyngeal course of the bilateral internal carotid arteries. There is a common origin of left common carotid artery and brachiocephalic artery. There is a persistent probable mucosal retention cyst within the left maxillary sinus. There is mild narrowing of the cervical spinal canal with mild spondylotic changes in the lower cervical spine. | Stable post treatment changes without evidence of recurrent tumor or cervical lymphadenopathy. |
Generate impression based on findings. | Female 24 years old Reason: follow up History: follow up. Four views of the right foot again show two orthopedic screws affixing the first tarsometatarsal joint in near anatomic alignment. We see no hardware complications. The articulation remains visible at this time. There is also postoperative flattening of the medial aspect of the 1st metatarsal head with adjacent soft tissue swelling. However the previously seen diffuse soft tissue swelling has decreased. A mottled appearance to the cortices of the third and fourth metatarsals likely reflects demineralization from disuse. | Postoperative changes of a Lapidus procedure, appearing similar to the prior study. |
Generate impression based on findings. | Female 41 years old Reason: right hip pain History: pain. The bones appear demineralized. On the AP view, there is an irregular bandlike lucency traversing the medial cortex of the base of the femoral neck; this is highly suspicious for fracture, presumably a stress fracture. The possibility of a Looser zone is also considered if the patient has known osteomalacia.There is a T-shaped contraceptive device in the pelvis. | Incomplete fracture of the medial aspect of the femoral neck, perhaps a stress fracture. This can be further evaluated with MRI if clinically warranted.Dr. Wei Wei Lee was verbally notified of these findings at 1145 am on 2/17/2015. |
Generate impression based on findings. | Ms. Walsh is a 42 year old female with a personal history of benign left breast biopsy performed at an outside hospital in 2/2014 with pathology results demonstrating a fibroadenoma. She has no current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. There is a subcentimeter benign morphology mass in the left superior breast with percutaneously placed biopsy marker clip. This presumably represents the biopsied fibroadenoma from the outside hospital based on the provided measurements from outside reports and presence of biopsy marker clip. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | Benign morphology mass in the left superior breast, presumably representing the biopsied fibroadenoma. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms are submitted, then an addendum to this report will be made.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 13-year-old female with toxic iron ingestionVIEW: Abdomen AP (one view) 2/17/15 10:34 No radiopaque foreign body. Nonobstructive bowel gas pattern. | Normal examination evidence of radiopaque foreign body. |
Generate impression based on findings. | Reason: evaluate follow-up for clear cell carcinoma of palate s/p resection History: follow-up imaging LUNGS AND PLEURA: Mild centrilobular emphysema.No evidence of pulmonary pleural metastases.Scattered focal scarring unchanged.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Moderate coronary artery calcification is present as well is calcification of the aortic root and the mitral annulus. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Stable benign-appearing left adrenal nodule. | No evidence of metastases, or other significant abnormality. |
Generate impression based on findings. | 75-year-old male status post adjuvant chemotherapy for pancreatic cancer. Evaluate for disease progression. Compared to 11/11/14. CHEST:LUNGS AND PLEURA: Bilateral pleural effusions have not significantly changed with persistent loculations in the left pleural effusions. Compressive atelectasis again seen. No parenchymal lung nodules or masses seen to suggest metastatic disease.MEDIASTINUM AND HILA: Mildly enlarged mediastinal lymph nodes have minimally changed from the prior study. There referenced lymph node in the precarinal space (series 7, image 39) measures 1.5 x 1 .2 cm, previously 1.7 x 1.3 cm. other smaller middle mediastinal lymph nodes are similar in appearance. No new foci of lymph node enlargement is seen.Postsurgical changes are again seen with severe coronary calcifications of the native coronary arteries.CHEST WALL: Postsurgical changes are again seen bilateral spinal fixation device across the lower thoracic and upper lumbar spine. Diffuse degenerative changes again seen. Compression wedge deformity of the T6 vertebral body with anterior compression is seen with slightly increased sclerosis.ABDOMEN:LIVER, BILIARY TRACT: Probable hemangioma again seen segment 4 (series 7, image 94) unchanged dating back to 12/2/13 examination. Slow circulation time results in minimal enhancement liver parenchyma with regional perfusional abnormalities but no lesions indicating metastatic disease and similar in appearance to prior examinations. However, due perfusion of the liver, if concern over liver metastatic disease exists, I would recommend an MR examination.Pneumobilia again seen from prior surgery with no other biliary tract abnormality seen.SPLEEN: No significant abnormality notedPANCREAS: Prior resection at Whipple procedure with similar appearance now to the pancreas as demonstrated on prior examinations. No evidence of recurrent tumor in the of the head of the pancreas is seen. Slight increased haziness about the root of the superior mesenteric artery is seen but is unchanged -- more confluent soft tissue density seen abutting the superior mesenteric artery (series 7, image 98) appears unchanged dating back to 7/29/14 making this unlikely to represent metastatic disease, however it is new since 4/29/14 and continued follow up to this area would be recommended.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonobstructing kidney stones again seen without other significant kidney abnormality seen. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia. Postsurgical changes as expected from prior Whipple procedure. No evidence of bowel obstruction noted no mesenteric masses or free mesenteric fluid seen.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Status post Whipple procedure/pancreatic resection with no significant change since most recent CT examination 11/11/14. 2. Soft tissue density adjacent to superior mesenteric artery is stable since July, 2014 and unlikely to represent metastatic disease, but since it is new since April, 2014, continued surveillance and attention to this region would be recommended. 3. Slow circulation time limits enhancement and evaluation of liver parenchyma -- no abnormalities are seen, but if concern over liver metastatic disease exists, I would recommend an MR examination. 4. Increasing anterior wedge deformity of mid thoracic wedge compression fracture. |
Generate impression based on findings. | Again noted are small subdural collections along the bilateral cerebral hemispheres with low attenuation, but slightly above that of CSF, measuring up to 7 mm in thickness on the left and 4 mm on the right. There is no significant mass effect on the adjacent brain parenchyma. There are no definite areas of abnormal hyperattenuation.Redemonstrated are small areas of encephalomalacia within the right middle frontal gyrus, left parietal lobe and right cerebellar hemisphere without significant interval change. There are scattered punctate and confluent areas of abnormal low attenuation in the periventricular and subcortical white matter and left thalamus, consistent with stable mild chronic small vessel ischemic changes. The ventricles and sulci are prominent, consistent with mild age-related volume loss. There is no midline shift. There is mild mucosal thickening of the right maxillary sinus. The other visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | Small bilateral subdural collections with low attenuation, unchanged from CT head dated 2/15/2015. |
Generate impression based on findings. | 33 years, Female. Reason: post-op retained foreign object History: post-op An epidural catheter projects over the upper lumbar spine. Postsurgical pneumoperitoneum noted. Nonobstructive bowel gas pattern. No unexpected radiopaque foreign objects. | No unexpected radiopaque foreign objects.Findings discussed with Dr. Della Torre via telephone at 3:23 PM by Dr. McCann. |
Generate impression based on findings. | Urinary tract cancer. LUNGS AND PLEURA: No suspicious nodules and no pleural effusions.Filling defects in the right middle lobe and right lower lobe pulmonary arteries consistent with emboli, of uncertain chronicity but potentially acute. The findings were discussed with Dr. Steinberg at the time of reporting.MEDIASTINUM AND HILA: No significant lymphadenopathy.Mild coronary artery calcification.No pericardial effusion.No sign of right heart strain.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Small hepatic and renal cysts. | 1. Small pulmonary emboli in the right middle lobe and right lower lobe arteries.2. No sign of metastatic disease in the thorax. |
Generate impression based on findings. | Neck pain. History of ACDF. There is fusion of the C3, C4, and C5 vertebral bodies. Severe degenerative disk disease affects C5/6 and C6/7. There are minimal retrolistheses of C5 and C6 which appear stable between the flexion, neutral, and extension views. There is loss of the normal cervical lordosis. There is a mild leftward curvature of the cervical spine and mild hypertrophy of the transverse processes of C7. | Degenerative disk disease of the lower cervical spine and vertebral body fusion as described above. |
Generate impression based on findings. | 7-week-old female status post cardiac surgery stable on LFNC. Evaluate left lower lobe focality.VIEWS: Chest AP/lateral (two views) 2/17/2015 Surgical clips again noted in the superior mediastinum.Cardiothymic silhouette is unchanged with persistent cardiomegaly. Lingular opacity has resolved. Persistent streaky retrocardiac opacities likely atelectasis. Flattening of hemidiaphragms suggestive of air trapping. No pleural effusion or pneumothorax. | Interval resolution of lingular opacity most consistent with atelectasis. Persistent left basilar atelectasis. Flattening of the hemidiaphragms suggestive of air trapping. |
Generate impression based on findings. | History of lumbar fusion. Evaluate stability of spine, hardware and bony fusion. Surveillance imaging. Evaluation of the lumbar spine is limited due to the patient's body habitus. The patient is status post multilevel laminectomy. Again seen are posterior rods with screws entering the L4 and L5 vertebrae. I see no hardware complications. Also again seen is an intervertebral spacer device at L4-5 with findings suggestive of at least partial fusion of the L4 and L5 vertebral bodies, appearing similar to the prior study. An intervertebral spacer device is also again seen at L3/4, containing bone graft material, appearing similar to the prior study. Again seen are grade 1 retrolistheses of L2 and L3 that appear similar to the prior study. I see no frank instability between the flexion, neutral, and extension views. Moderate degenerative disk disease affects L2/3. Mild-moderate degenerative disk disease affects the visualized lower thoracic spine. There is a slight leftward curvature of the thoracolumbar spine as seen on the AP view. There is calcification of the distal abdominal aorta. | Postoperative and degenerative changes of the spine appearing similar to those seen on the prior study. |
Generate impression based on findings. | 10-year-old male with neuroblastoma off therapy. Assess for progression of disease CHEST:LUNGS AND PLEURA: Bilateral subpleural pulmonary nodules as well as a left upper lobe subcentimeter nodule are unchanged. No new nodules are identified. No focal consolidations or pleural effusions.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: Stable sclerotic focus in the T8 vertebral body, likely bone island. ABDOMEN:LIVER, BILIARY TRACT: Again seen are three poorly defined arterial enhancing foci which are thought to represent hemangiomas. A segment 8 lesion (series 4, image 66) is poorly visualized now measures approximately 4 mm, previously 11 mm x 9 mm. A segment 6 lesion (series 4, image 83) measures 10 mm x 8 mm, unchanged. A segment 4b lesion (series 4, image 78) is poorly visualized but appears unchanged measuring up to 9 mm. The gallbladder is normal. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: The patient is status post left adrenalectomy and surgical clips are seenin the left adrenal bed.KIDNEYS, URETERS: Left kidney is slightly smaller than the right, similar to priorRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: A bone island in the anterior T11 vertebral body is unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. No specific evidence of recurrent disease.2. Previously identified enhancing hepatic lesions are less conspicuous on today's exam and thought to be benign hemangiomas. |
Generate impression based on findings. | Male 52 years old; Reason: 52 y/o male with a history of urothelial cancer, status post adjuvant chemotherapy. please assess for disease progression: PLEASE NOTE:CT UROGRAM, DELAYED VIEWS, 3D RECONSTRUCTION History: hx of urothelial cancer CHEST:LUNGS AND PLEURA: No dominant lung lesion. No pulmonary infarction. No pleural effusion.MEDIASTINUM AND HILA: Heart size is normal . No pericardial effusion. There are multiple subocclusive emboli in the right lower lobe pulmonary artery.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. Nonspecific subcentimeter hypodense foci in the left lobe of the liver. The hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal hyperdense cyst. No hydronephrosis or masses in either kidney.Ureters are normal in caliber and course. There is mild thickening of the left distal ureter near the ileal conduit.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Nonspecific changes in the mesentery adjacent to the ileal conduit. No mesenteric lymphadenopathy.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Status post cystoprostatectomyBLADDER: Status post cystoprostatectomyLYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Postsurgical changes from a cystoprostatectomy without evidence for metastatic disease.2.Right lower lobe pulmonary emboli.3.Findings discussed with Dawn Conway at the time of dictation |
Generate impression based on findings. | Female 58 years old Reason: rectal prolapse vs. intussusception History: possible prolapse of tissue There is prompt opacification of the rectum, sigmoid, and descending colon of normal static morphology.Trial straining showed markedly excessive descent of the perineal floor (series #10); voluntary anal sphincter contraction demonstrated expected perineal elevation.Formal straining and evacuation showed passage of rectal/neo-rectal contents with an anterior rectocele measuring approximately 2 cm in maximal axial dimension.No evidence of sinus tracts, fistulae, or anastomotic leaks. | Evacuation demonstrated an anterior rectocele measuring approximately 2.0 cm. Excessive mobility and descent of the pelvic floor when straining.No evidence of rectal prolapse or intussusception.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Three months status post PSF. Assess fusion. Again seen is an anterior plate with screws entering C4, C5, and C6. The C4 through C6 vertebral bodies are fused. There are also posterior rods entering C6 and C7, appearing similar to those seen on the prior study. I see no acute hardware complications. Severe degenerative disk disease affects C3/4 and C6/7. Alignment is within normal limits. | Postoperative changes of cervical spine fusion and degenerative disk disease appearing similar to the prior study. |
Generate impression based on findings. | Neck pain, upper extremity weakness. History of cervical myelopathy. Evaluate stenosis and instability. Evaluation of the cervicothoracic junction is slightly limited by overlying anatomy. Severe degenerative disk disease affects C3/4, and there is a grade 1 retrolisthesis of C3 that appear stable between the flexion, neutral, and extension views. Moderate degenerative disk disease affects C4/5 through C7/T1. There is a grade 1 retrolisthesis of C4 that appears grossly stable between the flexion, neutral, and extension views. | Degenerative disk disease and retrolistheses as described above. |
Generate impression based on findings. | 82-year-old male with bladder cancer status post cystectomy -- assess for recurrent disease. ABDOMEN:LUNG BASES: Calcified micronodules from prior granulomatous disease. No suspicious pulmonary nodules or masses seen. No pleural disease. Ventricular assist device unchanged.LIVER, BILIARY TRACT: Normal-appearing liver parenchyma and vascular structures. Gallstones again seen without other biliary tract complication. Right ureter line in nailSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Again seen are bilateral renal simple cysts unchanged. No hydronephrosis is seen. Prompt and symmetric contrast excretion is seen into normal appearing pyelocalyceal systems. The ureters are well visualized throughout nearly the entire course without abnormality.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia seen. Collapsed stomach and small bowel appear normal in the abdomen without obstruction or intrinsic abnormality. Lack of oral and IV contrast limits ability to evaluate the intestinal tract. Right inguinal pelvic hernia is again seen containing small bowel without complication. No free mesenteric fluid identified.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomyBLADDER: Status post cystectomy with left abdominal urinary conduit diversion unchanged in appearance.LYMPH NODES: No adenopathy BOWEL, MESENTERY: Right inguinal pelvic hernia is again seen containing small bowel without complication. No free mesenteric fluid identified.BONES, SOFT TISSUES: Left and hernia containing only mesenteric fat is seen. Degenerative changes seen about the lumbosacral spine and pelvis.OTHER: No significant abnormality noted | 1. status post cystoprostatectomy with ileal conduit urinary diversion without evidence of recurrent or metastatic disease. 2. No change in right inguinal hernia containing bowel without complication. 3. Left inguinal hernia containing only mesenteric fat. |
Generate impression based on findings. | Confusion, abnormal gait, urinary incontinence No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. Sulci and ventricles are prominent consistent with patient's age. There is moderate degree of global parenchymal volume loss. There is enlargement of the ventricular system which is favored to be on an ex vacuo basis. No extra-axial collections. There are moderate confluent areas of hypoattenuation in the periventricular and subcortical white matter which are nonspecific but favored to represent chronic small vessel ischemic changes and slightly progressed since 7/27/2011.The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact. | 1. No intracranial mass or mass-effect.2. Moderate chronic small vessel ischemic changes.3. Moderate degree of global parenchymal volume loss.4. There is prominence of the ventricular system which is likely related to advanced volume loss. However, a small component of communicating hydrocephalus cannot entirely be excluded and further evaluation with large volume tap can be considered if clinically appropriate. |
Generate impression based on findings. | Pain and swelling medial knee. Effusion? Mild osteoarthritis affects the knee. There is a large joint effusion. I see no fracture or malalignment. | Large joint effusion, nonspecific. |
Generate impression based on findings. | Status post left total hip arthroplasty The AP view of the hip shows components of a total hip arthroplasty device situated in near-anatomic alignment without radiographic evidence of complication. A drain and foci of gas density within the soft tissues reflect recent surgery.The AP view of the pelvis reveals the aforementioned postoperative changes on the left. Components of a right total hip arthroplasty device are situated in near-anatomic alignment. Degenerative arthritic changes affect the visualized lower lumbar spine. | Total hip arthroplasty as above. |
Generate impression based on findings. | Male 15 years old Reason: NG placement, s/p ex-lap History: increased NG outputVIEW: Abdomen AP (one view) 2/17/15 at 1147 hrs. NG tube terminates at the stomach. Almost complete paucity of abdominal gas. | NG tube terminates in the stomach. |
Generate impression based on findings. | Male, 74 years old, with history of squamous cell carcinoma of the skin and CLL, status post induction chemotherapy. Postsurgical findings are again seen in the right neck including scarring and infiltration particularly along the right sternocleidomastoid muscle. No discrete mass or pathologic adenopathy is detected at any point in the neck.The tail of the right parotid gland is infiltrated and scarred similar to prior. No additional lesions are seen in the major salivary glands, and the thyroid is unremarkable. The cervical vessels are not assessed adequately without contrast. No destructive osseous lesions are seen. Multilevel cervical spondylosis is redemonstrated similar to prior. | Postoperative findings in the right neck with no evidence to suggest recurrent mass or pathologic adenopathy. |
Generate impression based on findings. | Male 78 years old; Reason: patient with a history of renal cell cancer, please assess for disease progression History: RCC CHEST:LUNGS AND PLEURA: Small bilateral pleural effusions. No dominant lung lesion.MEDIASTINUM AND HILA: Heart size is normal. Severe coronary artery, thoracic aorta, and arch vessel calcification. Reference upper mediastinal lymph node measures 1.5 x 1.0 cm (image 30/series 3) previously, 1.6 x 1.0 cm.CHEST WALL: A venous catheter terminates in the right atriumOTHER: ABDOMEN:LIVER, BILIARY TRACT: Liver is normal in morphology. Hypodense lesions in the liver unchanged. Small amount of perihepatic ascites.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left ureter stent is in place. Solid mass in the lower pole of the left kidney measures 4.3 x 3.1 cm (image 126/series 4) previously, 4.1 x 2.8 cm.Right kidney is atrophic. Probable small cyst on its lateral aspect.RETROPERITONEUM, LYMPH NODES: Severe retroperitoneal lymphadenopathy. The reference conglomerate left para-aortic node mass measures 7.3 x 5.6 cm (image 126/series 3) previously, 7.5 x 6.3 cm..Abdominal aortic aneurysm measuring 4.2 cm in AP dimension.BOWEL, MESENTERY: Prominent mesenteric lymph nodes, unchanged.BONES, SOFT TISSUES: Anasarca.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis and rectal wall thickening of unclear etiology.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Calcific arteriosclerotic disease. | 1.No significant size change in the reference lesions. |
Generate impression based on findings. | 90 year-old female glands abdominal aneurysm -- evaluate for stent graft placement and Endo leak. Status post EVAR. CHEST:LUNGS AND PLEURA: Emphysematous changes seen scattered left basilar punctate micronodules unchanged since 7/22/14.MEDIASTINUM AND HILA: Atherosclerotic calcification seen the aorta without aneurysmal dilatation. No adenopathy or abnormal masses. Moderate coronary artery calcifications seen.CHEST WALL: Scattered subcentimeter thyroid nodules. No significant abnormality noted.ABDOMEN: Within the limits of a non-IV contrast enhanced examination which limits the ability evaluate solid parenchymal organs and vascular structures the following observations can be made:LIVER, BILIARY TRACT: No significant abnormality noted in the liver, lack of IV contrast markedly limits ability to evaluate. Gallstones without complication are again seen. No other biliary tract abnormality..SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic right kidney again seen. Left kidney shows apparent benign cysts unchanged, though the lack of IV contrast limits ability to completely characterize these lesions.RETROPERITONEUM, LYMPH NODES: Aortobiiliac stent is unchanged in its appearance and position stents into the origin of the SMA and the left renal artery are unchanged. Surrounding sac diameter has markedly decreased in size with maximal diameter now of 5.0 x 5.1 cm (series 5, image 101).No retroperitoneal adenopathy or abnormal masses are seen.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Calcifications in uterus presumably from fibroid tumors unchanged without other abnormality.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Sigmoid diverticular changes without complication.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Aortobiiliac endovascular stent unchanged in position and appearance. 2. Marked decrease in size of overlying sac size indicating no significant Endo leak. 3. Cholelithiasis without complication. |
Generate impression based on findings. | Female 40 years old; Reason: re-evaluate following additional systemic therapy; compare to previous scan and provide bi-dimensional measurements per RECIST 1.1; IRB 10-666 History: Stage IV melanoma CHEST:LUNGS AND PLEURA: No new lung lesions. The pleural spaces are clear. Subpleural reticulations along the anterolateral aspect of the right upper lobe possibly related to radiation.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Small left axillary lymph nodes. Right axillary scar like tissue measures 7 x 4 mm on image 16, series 12, unchanged. Pectus deformity.ABDOMEN:LIVER, BILIARY TRACT: Sub-centimeter hypervascular right hepatic lobe lesion in segment 6 (image 120 series 12) is too small to characterize and possibly represents a small hemangioma.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lucent T11 vertebral body lesion is unchanged.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Left adnexal cysts.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.Stable exam. |
Generate impression based on findings. | 67-year-old male with history bladder cancer status post radical cystectomy with neobladder -- evaluate for metastatic disease. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Low Attenuation liver is seen indicating diffuse hepatic steatosis. No focal parenchymal liver lesions are seen, although the presence of diffuse fat can obscure hepatic lesions. Gallbladder and biliary tract appear normal.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Resolution of the prior noted left hydronephrosis. Benign cyst is again seen in lateral right kidney and subcentimeter high density cyst is seen in the mid left kidney (series 4, image 56). Prompt and symmetric excretion of contrast material is seen into normal pyelocalyceal systems with opacification of the right ureter throughout its entire length without abnormality. The proximal and mid left ureter is visualized well without abnormality.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Cystoprostatectomy.BLADDER: Prior cystectomy with continent neobladder unchanged in position and appearance.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No diverticular changes without complication.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Cystoprostatectomy with continent neobladder unchanged in appearance. 2. No evidence of recurrent or metastatic disease seen. 3. Resolution of prior noted left hydronephrosis. 4. Diffuse hepatic steatosis. |
Generate impression based on findings. | Male 72 years old; Reason: restaging scans s/p 24 weeks of oral tki therapy History: hx of metastatic renal cell cancer CHEST:LUNGS AND PLEURA: Lingular nodule measures 0.9 x 0.5 cm (image 79/series 5) previously, 0.8 x 0.5 cm.Right upper lobe pulmonary nodule measures 4mm image 52 series 5, unchanged.Remainder of the pulmonary nodules have resolved. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. Precarinal lymph node measures 1.0 x 1.0 cm (image 43/series 3) previously, 1.6 x 1.4 cm.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Stable hepatic cysts. No new liver lesion.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right lower pole renal mass measures 3.2 x 2.9 cm (image 127/series 3) previously, 2.9 x 2.1 cm. which partially infiltrative in nature.No hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: Reference aortocaval lymph node measures 2.1 x 1.8 cm (image 141/series 3) previously, 2.1 x 2.0 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Left inguinal hernia containing portion of colon without obstruction.Degenerative changes affect the lumbar spine with grade 1 anterolisthesis of L5 on S1 due to bilateral pars defects.OTHER: No significant abnormality noted | 1.Near stable size measurements of the reference metastatic lesions.2.Slight size increase in the primary right renal neoplasm. |
Generate impression based on findings. | Acute versus acute-on-chronic knee pain Tricompartment osteophytes indicate mild to moderate osteoarthritis. I see no joint effusion. I see no fracture. Small ossicles are noted within the distal quadriceps and patellar tendons, which may not be of any current clinical significance. | Osteoarthritis without fracture evident. |
Generate impression based on findings. | 75-year-old female recurrent breast cancer to the left lung. Status post chemo and RT. LUNGS AND PLEURA: Increased left perihilar/upper lobe opacity with associated volume loss consistent with post-radiation reaction.Unchanged scattered calcified and noncalcified micronodules, most likely-postinflammatory.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion.Mild coronary artery calcification.Moderate hiatal hernia.CHEST WALL: Postsurgical findings a left lumpectomy. Left axillary dissection with surgical clips.No axillary lymphadenopathy.No suspicious focal osseous lesion.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Atherosclerotic calcification of the aorta. | 1. Increased left perihilar/upper lobe opacity consistent with post radiation change although residual tumor is in the differential diagnosis. No new sites of disease are identified. 2. Contrast extravasation, as described above. |
Generate impression based on findings. | Female; 75 years old. History of HCV and remote liver transplant. Uncontrolled hypertension evaluate for renal artery stenosis. ULTRASOUND KIDNEYSRIGHT KIDNEY: The right kidney measures 10.0 cm in length. Renal cortex is mildly echogenic. There is no hydronephrosis or shadowing renal stone. Multiple simple cysts are seen, a cyst within the inferior pole of the right kidney measures 1.2 x 1.1 x 1.4 cm. No worrisome mass is identified.LEFT KIDNEY: The left kidney measures 10.4 cm in length. The renal cortex is mildly echogenic. There is no hydronephrosis or shadowing renal stone. Multiple simple cysts are seen, a cyst within the inferior pole of left kidney is 0.8 x 0.7 x 0.5 cm simple renal cyst. No worrisome mass is identified.OTHER: The bladder is nondistended.DOPPLER VASCULAR KIDNEYS: Color and spectral Doppler were performed on inflow and outflow vessels.AORTA: Peak systolic velocity of 0.7 m/sec.RIGHT RENAL ARTERY: Proximal: Peak systolic velocity of 0.8 m/secMid: Peak systolic velocity of 0.9 m/secDistal: Peak systolic velocity of 0.2 m/sec RIGHT RENAL VEIN: No significant abnormality noted.LEFT RENAL ARTERY: Proximal: Peak systolic velocity of 0.5 m/secMid: Peak systolic velocity of 0.6 m/secDistal: Peak systolic velocity of 0.3 m/sec LEFT RENAL VEIN: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: No significant abnormality noted.ULTRASOUND ABDOMENLIVER: The liver measures 18.6 cm in length. The liver contour is smooth, the parenchyma is coarse in echotexture with no worrisome mass identified.The main portal vein is patent with hepatopetal flow and a peak velocity of 0.14 m/sec.GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. The common duct measures 3 mm. There is no intrahepatic biliary ductal dilatation.PANCREAS: The pancreas is not well visualized due to overlying bowel gas.SPLEEN: The spleen is mildly enlarged measuring 13.9 cm in length.RIGHT KIDNEY: Right kidney measures 10.0 cm in length. Renal cortex is mildly echogenic. There is no hydronephrosis or shadowing renal stone. Multiple simple cysts are seen, a representative cyst within the inferior pole of the right kidney measures 1.2 x 1.1 x 1.4 cm. No worrisome mass is identified.OTHER: Note is made of an anterior abdominal wall hernia near the bladder. | 1.Bilateral simple renal cysts.2.No evidence for renal artery stenosis.3.No worrisome hepatic mass. |
Generate impression based on findings. | Curvature to finger. There is a peculiar deformity of the middle phalanx of the fifth finger consisting of what appears to be a defect along the ulnar aspect of the bone which contains a 7 mm semicircular ossicle that is perhaps partially fused with the underlying phalanx. There is also slight ulnar inclination of the proximal articular surface and radial inclination of the distal articular surface of the phalanx. This results in radial angulation of the distal phalanx relative to the long axis of the proximal phalanx. | Middle phalangeal deformity as described above. |
Generate impression based on findings. | 9-year-old female, postoperative evaluationVIEWS: Pelvis, AP (one view) 2/17/15 12:39 Plate and screws affix bilateral femoral osteotomies. The femoral heads are well directed into the acetabula with dysplasia of the left acetabulum again noted. No evidence of hardware complication. Moderate rectal stool collection. | Bilateral VDRO procedures without evidence of complication. |
Generate impression based on findings. | Paraneoplastic limbic encephalitis. Question of evidence of malignancy.RADIOPHARMACEUTICAL: 11.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 112 mg/dL. Today's CT portion grossly demonstrates a 7 mm pulmonary micronodule in the left upper lobe. There are mildly enlarged prevascular lymph nodes. There are additional partially calcified right paratracheal, right hilar, and subcarinal lymph nodes suggestive of prior granulomatous disease. A right internal jugular central venous catheter terminates in the SVC. There are mild coronary artery calcifications. There is mild fat stranding around the gallbladder which is similar to the prior examination. There is colonic diverticulosis without CT evidence of diverticulitis. There are bilateral maxillary sinus retention cysts/polyps. Today's PET examination demonstrates a subcentimeter mild to moderately hypermetabolic pulmonary nodule in the left upper lobe measuring a max SUV of 2.0. There is a markedly hypermetabolic prevascular lymph node (max SUV of 8.6). Mild focal activity is also noted within the right hilum, which is non-specific. Increased FDG activity within the aortic root and wall may represent atherosclerotic disease. Increased uptake within the lower sternum and anterior chest wall may be secondary to inflammation. Asymmetric increased FDG uptake is noted within the right medial temporal lobe.There is a focus of hypermetabolic activity within the distal descending/sigmoid colon junction, which appears to correlate with intraluminal soft tissue density.A linear band of increased FDG uptake within the left perineum with corresponding skin thickening and fat stranding is concerning for an infectious/inflammatory process. | 1. Markedly hypermetabolic prevascular lymph node and left upper lobe pulmonary micronodule are highly suspicious for malignancy. Mild activity in the right hilum is non-specific.2. Markedly hypermetabolic focus within the descending/sigmoid colon with corresponding soft tissue density on CT may represent a polyp and/or possibly malignancy; correlate with history of colonoscopy and/or consider direct visualization. 3. Asymmetric right medial temporal lobe activity; this may represent limbic encephalitis as seen on the prior MRI, status epilepticus, or less likely neoplasm. 4. Increased FDG activity, skin thickening, and fat stranding in the left perineum is concerning for an infectious/inflammatory process such as cellulitis; direct visualization is suggested. |
Generate impression based on findings. | History of pancreatic cancer, restaging following neoadjuvant therapy CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. Mild apical scarring.MEDIASTINUM AND HILA: Right central venous chest port with tip at the SVC atrial junction. Trace pericardial fluid (series 12, image 81) new from prior. Calcified mediastinal and hilar lymph nodes compatible with prior granulomatous disease. No noncalcified enlarged mediastinal lymph nodes. CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Scattered tiny low-attenuation hepatic foci are too small to characterize but are unchanged from the prior exam. Mild intrahepatic biliary ductal dilatation, similar to prior. Interval placement of a common bile duct stent with distal tip in the duodenum. SPLEEN: No significant abnormality notedPANCREAS:Primary tumor: 2.1 cm x 2.5 cm x 2.8 cm hypoattenuating mass in the pancreatic head/uncinate process (series 12, image 125; series 80736, image 43), previously measured 1.8 x 2.2 x 2.4 cm (series 10, image 49; series 80740, image 39). Previously reported measurement of 3.2 cm x 4.3 cm x 4.2 cm in retrospect is thought to include portions of the duodenum.There are several low attenuation cystic lesions which appear to arise from the main pancreatic duct, increased from prior, and thought to be related to chronic pancreatic duct obstruction.Pancreatic duct: 6 mm, previously 6 mm. Mesenteric Arteries:Arterial anatomy: Conventional.Arterial tumor abutment or encasement: (1) Proximal celiac artery, SMA, and hepatic artery: No abutment or encasement.(2) Tumor abutment or encasement of additional arteries: 180 degrees abutment of the distal GDA.Mesenteric Veins:Venous anatomy: (1) Superior mesenteric vein (SMV) first jejunal branch: anterior to SMA. Venous tumor abutment or encasement: SMV-PV-splenic vein confluence: 180 degrees abutmentSMV, PV, or segmental SMV-PV occlusion: None.Inferior vena cava (IVC): Patent.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Prominent left para-aortic lymph node (series 12, image 112) measures 2.2 x 1.0 cm, similar to prior. Additional subcentimeter gastrohepatic and peripancreatic lymph nodes are also similar to prior.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine. OTHER: No peritoneal nodules or peritoneal free fluid.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No peritoneal nodules or peritoneal free fluid. | 1.Pancreatic head/uncinate process mass compatible with patient's known adenocarcinoma, slightly increased in size from prior. The mass continues to abut approximately 180 degrees of the GDA and the porto-splenic confluence.2.Interval placement of common bile duct stent. 3.New trace pericardial fluid. |
Generate impression based on findings. | 15-year-old female with hip pain.VIEWS: Left hip AP, lateral, crosstable lateral (3 views) 2/17/2015 11:33 There are geographic areas of lucency throughout the proximal femur. No evidence of periosteal reaction. No fracture or dislocation. | Findings suggestive of osteomyelitis or osteonecrosis of the left proximal femur. |
Generate impression based on findings. | Left hip pain Three views of the left hip are provided. Severe osteoarthritis affects the hip, with bone on bone apposition superiorly.The AP view the pelvis shows the aforementioned severe osteoarthritis of the left hip. Moderate osteoarthritis affects the right hip. Overall, the bones appear demineralized, suggesting osteopenia. Chronic appearing enthesopathic changes are noted along the iliac wings. Evaluation of the sacrum is limited by overlying bowel contents. Degenerative arthritic changes affect the visualized lower lumbar spine. | Severe osteoarthritis as above. |
Generate impression based on findings. | Female 84 years old; Reason: worsening SOB with COPD; increasing renal insufficiency in setting of history of rectal cancer, S/P ostomy; history of SBO;s History: as above CHEST:LUNGS AND PLEURA: Left lower lobe pulmonary nodule measures 5 mm on image 64/series 4 previously, 11 mm.MEDIASTINUM AND HILA: Heart size is mildly enlarged. Coronary calcifications and vascular calcifications. No mediastinal lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidney cortices are atrophic. There is a cyst at the upper pole of the left kidney. No nephrolithiasis or hydronephrosis in either kidney.RETROPERITONEUM, LYMPH NODES: Calcific arteriosclerotic disease affects the aorta. No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: Left abdominal ostomy contains portion of colon with a parastomal component.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: Postsurgical changes in the bowel.BONES, SOFT TISSUES: Bilateral hip prosthesis. Scoliotic changes affects the thoracolumbar spine. OTHER: Evaluation of the deep pelvis is limited due to metal artifact from the hips. | 1.Atrophic kidneys without hydronephrosis.2.Left lower abdominal ostomy without evidence of obstruction.3.No specific evidence of metastatic disease. |
Generate impression based on findings. | 46-year-old female is history of hemangioendothelioma of vertebrae and liver; please compare target lesion measurements the 12th 3/13 in foci 2/14 examination. Bilateral pelvic pain. CHEST:LUNGS AND PLEURA: Segment right lower lobe groundglass is unchanged (series 6, image 44). A reticulonodular opacities in the anterior left upper lobe (series 6, image 27) and the multiple confluent nodular opacities in the left lower lobe abutting the major fissure (series 6, image 81) are also unchanged. No new mass lesions or nodules are seen to suggest metastatic disease. No pleural disease is seen.MEDIASTINUM AND HILA: No adenopathy or other significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Liver parenchyma again shows multiple diffuse peripheral based lesions that subjectively have not significantly changed. Specific reference measurements and comparisons are provided below, although in some cases where these lesions have become confluent with other lesions comparison of measurements are difficult.Segment 4 a lesion: (series 4, image 98) measures 1.4 x 1 .5 cm, previously 1.6 x 1.5 cm.Segment 7 lesion (series 4 , image 92): 4.0 x 2 .7 cm, previously 3.9 x 2.8 cm.Segment 8 anterior peripheral lesion (series 4 on image 89) measures 4.8 x 1 .2 cm, previously reported as 5.0 x 1.9 cm. However this measurement on 12/2/14 appeasr to include the adjacent diaphragm and my remeasuring this lesion without the adjacent diaphragm obtains measurements of 5.0 x 1.2 cm.Segment 6 lesion (series 4, image 104): 4.3 x 1 .9 cm, previously 4.0 x 1.8 cm. This lesion is extremely difficult to obtain accurate long axis measurements now because it has become confluent anteriorly with other adjacent lesions and cannot be separated nor differentiated. This is no longer a reliable comparison long axis dimension although the short axis dimension remains reliable. SPLEEN: No significant abnormality noted..PANCREAS: No significant abnormality noted..ADRENAL GLANDS: No significant abnormality noted..KIDNEYS, URETERS: No significant abnormality noted..RETROPERITONEUM, LYMPH NODES: Scattered subcentimeter retroperitoneal lymph nodes are again seen slightly prominent but not changed. No new foci of lymph node enlargement are seen in the lymph nodes of meat size criteria for lymphadenopathy are seen..BOWEL, MESENTERY: No significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality noted..OTHER: No significant abnormality noted..PELVIS:UTERUS, ADNEXA: No significant abnormality noted..BLADDER: No significant abnormality noted..LYMPH NODES: No significant abnormality noted..BOWEL, MESENTERY: No significant abnormality noted..BONES, SOFT TISSUES: No significant abnormality noted..OTHER: No significant abnormality noted.. | 1. Stable lung parenchymal findings with right lower lobe groundglass nodule, left upper lobe reticular nodular changes and. Left lower lobe confluent nodular opacities of uncertain significance. 2. Multiple peripheral based hepatic lesions typical of hemangioendothelioma with no significant change since 12/2/14 CT examination. Please see above measurements and discussion concerning nature of some of these lesions making comparison measurements difficult. 3. No new foci of disease identified. |
Generate impression based on findings. | Male 76 years old Reason: hx of pancreas ca on watchful waiting, please compare size with previous ct History: previous weight loss, now gaining weight, slowly rising CA 19-9. CHEST:LUNGS AND PLEURA: Interval development of small bilateral pleural effusions. No suspicious nodules or masses.MEDIASTINUM AND HILA: Mild cardiomegaly with small pericardial effusion. Mild atherosclerotic calcifications of the aorta with moderate coronary artery calcifications.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No evidence of liver metastases. Punctate calcifications in the liver consistent prior granulomatous disease.SPLEEN: No significant abnormality notedPANCREAS: Complex, multiseptated lesion which occupies the majority of the body and tail of the pancreas. The lesion has increased in size measuring 9.9 x 6.7 cm (series 9, image 54), previously 8.5 x 5.9 cm on CT from 6/30/2014. No vascular involvement. The portal vein and SMV appear patent.The celiac axis and SMA are also patent.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No regional lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Mildly dilated air-filled rectum and sigmoid colon. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Interval increase in size of the complex, multiseptated pancreatic lesion consistent with mucinous cystic neoplasm without vascular involvement or regional adenopathy. No evidence of distant metastases.2.New small bilateral pleural effusions. |
Generate impression based on findings. | Reason: Pleural mesothelioma. Please compare to prior exam per RECIST criteria. History: Pleural mesothelioma CHEST:LUNGS AND PLEURA: Postoperative changes of a right pleurectomy and decortication. Mild slightly nodular thickening of the right lung fissures remains similar in appearance to the prior exam. No significant pleural effusion.Continued interval decrease of a right major fissure soft tissue density lesion, possibly loculated fluid, now measuring approximately 17 x 14 mm (series 4, image 45), previously measuring 23 x 22 mm.Reference measurements are as follow:At the level of the main pulmonary artery (series 3, image 38): The lesion at the two o'clock position measures 3 mm, unchanged. The lesion at the one o'clock position measures 0 mm, unchanged.At the level of the right atrial appendage (series 3, image 53): The lesion at the 9 o'clock edition measures approximately 3 mm, unchanged. Lesion at the 4 o'clock position measures approximately 3 mm, unchanged.At the level of the tricuspid valve (series 3, image 66): There remains no measurable disease at the 4 o'clock and 9 o'clock positions.A previously referenced subpleural nodule measures approximately 4 x 3 mm (series 4, image 52), decreased in size from the prior exam.The left lung remains clear.MEDIASTINUM AND HILA: Surgical absence of the right thyroid lobe.The heart is normal in size without pericardial effusion. No visible coronary artery calcification.A previously described pretracheal lymph node (series 3, image 26) measures 8 mm, unchanged. No new mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative disease of the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: Subcentimeter hypodense lesion in the tail of the pancreas (series 3, image 94) is unchanged.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.Stable postoperative changes of a right pleurectomy and decortication.2.Stable pleural disease, with reference measurements as given above.3.Right major fissure soft tissue density continues to decrease in size possibly loculated fluid. |
Generate impression based on findings. | 34 years old female. Reason: Medically refractory epilepsy. Unable to localize on scalp EEG. Brain CT portion of the study is not remarkable. FDG PET imaging demonstrates minimally decreased FDG uptake in the right hippocampus. Otherwise, there is symmetrical normal cerebral and cerebellar metabolic activity. | Minimally decreased metabolic activity in the right hippocampus. |
Generate impression based on findings. | The internal auditory canals are symmetrical and normal in size and signal intensity. The inner ears are normal, with normal T2 signal and no pathological enhancement. No abnormal mass or abnormal enhancement is seen within the cerebellopontine angle, cisterns bilaterally or within the internal auditory canals. The individual nerves within the internal auditory canals are suboptimally delineated secondary to technique.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are numerous scattered foci of T2/FLAIR hyperintensity within the subcortical and deep white matter, with more prominent areas in the periventricular white matter along the posterior body of the lateral ventricles. There is subtle T2 hyperintensity within the midbrain bilaterally, which more likely relates to prominent perivascular spaces. There are no areas of pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. | 1. Multiple scattered foci of nonenhancing T2/FLAIR hyperintensity within the supratentorial white matter bilaterally. Differential diagnosis includes/inflammatory etiologies, demyelinating disease, chronic small vessel ischemic changes, or migraine headaches. Please correlate clinically.2. Unremarkable MR appearance of the IACs, with slight limitation in delineation of the nerves within the canal on T2 weighted sequences. |
Generate impression based on findings. | 56 years, Female. Reason: Dobbhoff placement History: Dobbhoff placement Note that the pelvis is excluded from the field-of-view. Nonobstructive bowel gas pattern. Enteric feeding tube tip projects over the gastric body. The lung bases are clear. | Enteric feeding tube tip projects over the gastric body. |
Generate impression based on findings. | Right elbow swelling. Low back pain. Hip pain RIGHT ELBOW: No fracture or malalignment is present. PELVIS: The bones appear demineralized. No fracture or malalignment is present. Mild degenerative changes affect the bilateral hip joints. LUMBAR SPINE: Severe degenerative disk disease is unchanged, with formation of large osteophytes. Moderate dextroscoliosis is not significantly changed. The vertebral body heights are preserved. No evidence of superimposed instability. | Degenerative changes, as above. |
Generate impression based on findings. | 38-year-old male with history of hemorrhoids and sensation of incomplete evacuation of bowel No external hemorrhoids or rectal prolapse was noted on insertion of Foley catheter. There is prompt opacification of the rectum, sigmoid, and descending colon of normal static morphology.Trial straining showed appropriate descent of the perineal floor; voluntary anal sphincter contraction demonstrated expected perineal elevation.Formal straining and evacuation showed decreased passage of rectal contents with presence of an anterior rectocele and a small posterior rectocele. No hemorrhoids or rectal prolapse was noted during the study. No evidence of sinus tracts, fistulae. Subsequently, the patient was asked to evacuate into the toilet. Post-evacuation images showed significant emptying of the rectum and colon suggesting lack of decreased passage was not due to an organic cause. Physical examination at the end of the study demonstrated mild rectal prolapse with visualized hemorrhoids. No blood was present. | Moderate anterior and small posterior rectocele. Perineal floor mechanics are within normal limits. Physical examination revealed rectal prolapse with hemorrhoids although acquired images did not demonstrate this finding. |
Generate impression based on findings. | Stage IB1 cervical cancer. Assess for metastatic disease. RADIOPHARMACEUTICAL: 14.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 88 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 a focus of hypermetabolic activity within the lower uterine segment/cervix (max SUV of 3.9). Increased FDG avidity within the bilateral ovaries likely represents functional cysts. No suspicious FDG lesion is identified in the neck, chest, and/or abdomen. Mild increased FDG activity of the aortic wall may represent atherosclerosis. | 1. Increased FDG activity within the lower uterine segment/cervix correlating with provided history of malignancy.2. No evidence of FDG avid metastatic disease in the neck, chest, abdomen, and pelvis. Diagnostic CTs of the chest, abdomen, and pelvis also performed at today's visit will be reported separately. |
Generate impression based on findings. | 83 years, Female. Reason: rule out mass vs. stool collection History: pain and tenderness with nausea Radiodensities compatible with gallstones project over the right upper quadrant. Nonobstructive bowel gas pattern. Average stool burden in the colon. Sternotomy hardware noted. The lung bases are clear. | Nonobstructive bowel gas pattern with average stool burden. |
Generate impression based on findings. | 12 year old boy with Dandy-Walker, headaches, rule out shunt malfunctionVIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views), abdomen AP/lateral (two views) 11/6/2014 The shunt catheter is seen with proximal tip in the right middle cranial fossa. The shunt catheter exits via a right occipital burr hole and courses down the soft tissues of the right neck and anterior chest wall. The shunt catheter that enters the abdomen in the right upper quadrant and is coiled with the distal tip in the pelvis. There is no kinkking or discontinuity of the radiopaque portions of the shunt catheter. The cardiothymic silhouette appears normal and no focal pulmonary opacities are identified. Nonobstructive bowel gas pattern. | No kinking or discontinuity of the shunt catheter. |
Generate impression based on findings. | 69 years, Female. Reason: obstruction? History: constipation x 2 weeks No evidence of pneumoperitoneum on upright images. Nonobstructive bowel gas pattern. Slightly greater than average stool burden in the colon. | Nonobstructive bowel gas pattern with greater than average stool burden in the colon. |
Generate impression based on findings. | Female 62 years old Reason: RA pt, please obtain flex/extension C-spine films to compare to prior History: RA pt, please obtain flex/extension C-spine films to compare to prior C2/C3: There is 1 mm of retrolisthesis of C2 that corrects on flexion. C3/C4: There is 1 to 2 mm of anterolisthesis of C3 elicited on flexion.C4/C5: There is approximately 2 mm of anterolisthesis of C4 that increases to 3 mm on flexion and decreases to 1 mm on extension.C5/C6: There is approximately 1 mm of anterolisthesis of C5 that increases to approximately 3 mm on flexion. There is moderate degenerative disk disease at C5/C6.C6/C7: There is moderate to severe degenerative disk disease at C6/C7 with irregularity of the endplates which may reflect erosion. There is approximately 4 mm of anterolisthesis of C6 that appears grossly stable between the flexion, neutral, and extension views.We see no atlantoaxial instability between the flexion, neutral, and extension views. There is moderate multilevel facet joint osteoarthritis and neuroforaminal narrowing bilaterally. Overall, these findings appear similar to those seen on the prior study. Please note that the dens is not well-visualized due to overlying anatomy. | Arthritic changes of the cervical spine as described above, appearing similar to those seen on the prior study. |
Generate impression based on findings. | 74 year old male. History of recurrent skin cancer and CLL. Status post induction chemo. Compare to previous. CHEST:LUNGS AND PLEURA: Stable scattered micronodules, likely post-inflammatory. Reference left upper lobe micronodule is 3 mm, previously 4 mm (series 7, image 37), not significantly changed.MEDIASTINUM AND HILA: Prominent mediastinal lymph nodes, not significantly changed. Subcarinal reference lymph node is 9 x 26 mm (series 5, image 41), previously 11 x 31 mm and reference precarinal node is 8 x 13 mm (series 5, image 41), unchanged. Mild ectasia of the ascending thoracic aorta, unchanged.Severe coronary artery calcification.Normal heart size without pericardial effusion.CHEST WALL: No axillary lymphadenopathy.Minimal degenerative changes of the thoracolumbar spine.ABDOMEN: Absence of IV and 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: Stable renal hypodensities, likely cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference celiac node is 11 x 8 mm (series 5, image 102), unchanged. BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Minimal degenerative changes of the thoracolumbar spine. Post-surgical findings of laminectomies in the lower lumbar spine.OTHER: No significant abnormality noted. | Stable borderline enlarged chest and abdominal lymph nodes. No new sites of disease. |
Generate impression based on findings. | Ms. McMillian is a 63 year old female with a personal history of left breast lumpectomy in June 2012 for triple negative IDC followed by chemotherapy and radiation. She has no current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the left breast. There are stable postsurgical changes including architectural distortion, increased density, and surgical clips present within the left lumpectomy site. Surgical clips are also present within the left axilla. Several benign morphology masses in the right breast are stable when compared back to 2010. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | Stable postsurgical changes of the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Redemonstrated is a soft tissue nodule within the left infratemporal fossa, just posterior to the zygoma, which measures 14 x 7 mm, previously 14 x 8 mm. Very subtle remodeling of the adjacent bone is again noted and unchanged.No new soft tissue lesions are demonstrated. No destructive osseous lesions are seen. The orbital contents are within normal limits. There is new mild mucosal thickening of the right frontoethmoidal recess and right anterior ethmoid air cells. The remaining paranasal sinuses, mastoid air cells and middle ear cavities are clear. | Stable left infratemporal fossa soft tissue nodule. |
Generate impression based on findings. | RIGHT TEMPORAL BONE: The external auditory canal is clear. The tympanic membrane is faintly visualized. The scutum remains sharp.There is complete opacification of the middle ear cavity and the mastoid air cells. The right stapes is difficult to visualize. The remainder of the ossicular chain and tegmen tympani are intact.The cochlear apex is amorphous and not well formed. The basal and middle cochlear turns appear intact. The modiolus is diminutive in size. The bony coverings of the cochlea, vestibule, semicircular canals, and facial nerve canal are intact. The vestibular aqueduct is significantly enlarged in size, measuring at least 5 mm in width at the operculum. No abnormalities of the osseous internal auditory canal are demonstrated.LEFT TEMPORAL BONE: The external auditory canal is clear. The tympanic membrane is faintly visualized. The scutum remains sharp.The tympanic cavity and middle ear cavity are clear. The ossicular chain and tegmen tympani are intact. There is scattered opacification of the left mastoid air cells.The cochlear apex is amorphous and not well formed. The basal and middle cochlear turns are grossly intact. The modiolus is diminutive. The bony coverings of the cochlea, vestibule, semicircular canals, and facial nerve canal are intact. The vestibular aqueduct is enlarged in size, measuring 3 mm in width at the operculum. No abnormalities of the osseous internal auditory canal are demonstrated. | 1. Bilateral enlarged vestibular aqueducts, right greater than left.2. Somewhat amorphous bilateral cochlear apices, suggestive of mild likely associated bilateral cochlear dysplasia.3. Complete opacification of the right mastoid air cells and middle ear cavity, which is nonspecific and may be reactive. Please correlate clinically. |
Generate impression based on findings. | 75-year-old male with history of renal cancer and chest mass. CHEST:LUNGS AND PLEURA: Left apical soft tissue attenuation mass (series 4, image 10) measures 1.8 x 2.7 cm and is nonspecific. Differential considerations include primary lung malignancy, metastasis, or inflammatory pleural process. Multiple additional subcentimeter nodules are suspicious for metastatic lesions.MEDIASTINUM AND HILA: Calcified mediastinal and hilar lymph nodes suggest prior granulomatous disease. Additional nonspecific right hilar lymph node (series 2, image 56) measures 1.1 cm in short axis.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Ill-defined heterogenous mass in hepatic segment 8 (series 3, image 88) measures approximately 10.5 x 12.4 cm and is compatible with metastasis. No additional focal hepatic lesions are identifiedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. Heterogenous mass in the left nephrectomy bed (series 3, image 113) measures 6.9 x 7.2 cm consistent with tumor recurrence. Portions of the mass invade the left psoas muscle. Mildly enlarged adjacent lymph nodes. Right renal subcentimeter low attenuation lesions too small to characterize. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There is a heterogenous enhancing mass in the left paraspinal muscles (series 3, image 120) measuring 3.4 x 4.1 cm compatible with metastasis. There is a moderate compression deformity of L1 which has progressed compared to the 2014 MRI and which may be related to an additional metastatic lesion. There is at least moderate spinal canal stenosis at this level. Additional mild superior end plate deformity of T8.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: There is a heterogenous enhancing mass in the left paraspinal muscles (series 3, image 120) measuring 3.4 x 4.1 cm compatible with metastasis. There is a moderate compression deformity of L1 which has progressed compared to the 2014 MRI and which may be related to an additional metastatic lesion. There is at least moderate spinal canal stenosis at this level. Additional mild superior end plate deformity of T8.OTHER: No significant abnormality noted | 1.Status post left nephrectomy.2.Recurrent tumor in the left nephrectomy bed which invades the left psoas muscle. Additional metastatic lesions in the left paraspinal muscles, liver, and probably lung. 3.Moderate compression deformity of L1 which has progressed compared to the 2014 MRI and may be related to an additional metastatic lesion. There is at least moderate spinal canal stenosis at this level. In the appropriate clinical setting, MRI of the lumbar spine may be helpful for additional evaluation. 4.No comparison CT exams were available at the time of this dictation. If comparison exams become available, an addendum can be issued for comparison. |
Generate impression based on findings. | The internal auditory canals are symmetrical and normal in size and signal intensity. The bilateral cochlear apices are somewhat amorphous and not well formed. The inner ears are otherwise intact, with normal T2 signal and no pathological enhancement. No abnormal mass or abnormal enhancement is seen within the cerebellopontine angle, cisterns bilaterally or within the internal auditory canals. There is complete opacification and enhancement of the right middle ear cavity and mastoid air cells, with enhancement. There is scattered opacification of the left mastoid air cells, also enhancing. The right vestibular aqueduct is enlarged in size, measuring at least 5 mm in width. The left vestibular aqueduct is also enlarged in size, when correlated with the CT temporal bones. The seventh and eighth cranial nerves are well visualized and are within normal limits.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. The pattern of myelination is appropriate for age. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. | 1. Bilateral enlarged vestibular aqueducts, right greater than left.2. Somewhat amorphous bilateral cochlear apices as seen on CT, suggestive of mild bilateral cochlear dysplasia.3. Complete opacification of the right mastoid air cells and middle ear cavity, which is nonspecific. Please correlate clinically |
Generate impression based on findings. | 9-day-old male status post PICC placementVIEW: Chest AP (one view) 2/17/15 NG tube side port in the distal thoracic esophagus. ETT tip is above the thoracic inlet. UVC catheter tip unchanged in position. A right sided catheter tip projects over the superior SVC.Extensive left predominant basilar airspace opacities increased from the prior exam. The cardiothymic silhouette is obscured. | ETT tip above the thoracic inlet. NG tube side-port in the distal thoracic esophagus. Interval increase in extensive patchy basilar air space opacities. |
Generate impression based on findings. | 67 years, Female. Reason: eval for ileus History: see above Multiple dilated loops of small bowel are seen in the midabdomen, measuring up to 3.5 cm in diameter. No pneumatosis or gross pneumoperitoneum seen.Findings compatible with prior right pneumonectomy and left lung airspace opacities are better evaluated on chest radiograph performed the same day. | Multiple dilated loops of small bowel in the midabdomen. Cannot exclude a complete small bowel obstruction. If symptoms persist, a CT scan can be considered. |
Generate impression based on findings. | Ms. Shannon is a 56 year old female with a personal history of right breast lumpectomy in August 2012 for IDC followed by chemotherapy, radiation, and Arimidex. Personal history of bilateral benign breast biopsies. Family history of breast cancer in two paternal aunts. Three standard views of both breasts with two right spot magnification views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the right breast. There are stable postsurgical changes including architectural distortion, increased density, and surgical clips present within the right lumpectomy site. A benign morphology mass with a ribbon clip is noted in the right upper outer breast (superior to the lumpectomy bed), which is a biopsy proven fibroadenoma. A rod shaped clip from a benign biopsy is noted in the left medial breast. Scattered benign calcifications are present bilaterally. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | Stable postsurgical changes of the right 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. | Male 59 years old Reason: fracture History: fracture. We have 3 views of the left ankle which again show an oblique fracture of the distal fibula and a transverse fracture of the medial malleolus with the fracture fragments in near anatomic alignment. Fracture lines remain visible, appearing similar to those seen on the prior study. | Distal fibular and medial malleolus fractures appearing similar to the prior study. |
Generate impression based on findings. | Male 67 years old Reason: Healed fx History: pain. We have 3 views of the right wrist showing sclerosis within the distal radius as well as callus formation along the dorsal radius, indicating a healing fracture. The fracture extends to the articular surface, with a minimally displaced fragment seen along the dorsal aspect of the sigmoid notch on the oblique view. | Healing distal radius fracture. |
Generate impression based on findings. | 50 year-old male with concern for small bowel obstruction on x-ray. ABDOMEN:LUNG BASES: Is too numerous to count again seen at the lung bases similar to prior chest CT examination. Small amount loculated right pleural fluid again seen.LIVER, BILIARY TRACT: Hypodense lesion too small to characterize seen and segment 4 superiorly (series 3, image 27) measuring 1.1 x 0.8 cm. Additional smaller lesions are seen adjacent to the gallbladder (series 3, image 41 and 40). Largest of these peripheral subcapsular lesions typical of hemangioendothelioma measures 1.2 x 0.9 cm.Hepatic vasculature appears normal. Gallbladder and biliary tract appear normal.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: Administered contrast rapidly no is a normal-appearing stomach into appearing small bowel without excessive distention and no significant retained intraluminal and contrast moves rapidly to the right lower quadrant with no evidence of obstruction. Contrast material is seen as expected in the colon which is also filled with fecal material. No intrinsic abnormality is seen in the intestinal tract. Small amount of free mesenteric fluid is seen in the dependent lateral and pelvic spaces without loculation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic lesion in the left sacrum (series 3 , image 110) with lucent center is seen unchanged since outside CT examination 11/27/12 of benign nature.OTHER: No significant abnormality noted | 1. No change In appearance of innumerable lung nodules at the lung bases. 2. Several small hepatic parenchymal lesions, too small to characterize but metastatic disease cannot be excluded. Peripheral nature of the largest of these is very suggestive of metastatic disease. 3. No evidence of intestinal bowel obstruction. Distended small bowel loops with air fluid levels seen on 2/16/15 computed radiographic no longer present and no distention is seen. 4. small amount of free peritoneal fluid. |
Generate impression based on findings. | Female 62 years old Reason: fall on 2/14; right hand/wrist pain, swelling, bruising History: fall on 2/14; right hand/wrist pain, swelling, bruising. There is a spiral/oblique nondisplaced fracture of the fifth metacarpal diaphysis. The carpal bones and bones of the fingers appear intact. | Fifth metacarpal fracture as described above.These findings were verbally relayed to Dr. Diane Altkorn on 2/17/2015. |
Generate impression based on findings. | Status post left elbow fracture.VIEWS: Left elbow AP and lateral 2/17/15 (two views) Cast material obscures fine bone detail. Four K wires are affixing a healing supracondylar fracture to near anatomic alignment. | Healing fracture in near anatomic alignment after pinning and casting. |
Generate impression based on findings. | 68 years, Male, Reason: Abdominal pain History: Abdominal pain s/p liver bx. History of melanoma ABDOMEN:LUNG BASES: New small right pleural effusion. Right basilar atelectasis with patchy peripheral opacities which likely represent hemorrhage/infarction from patient's known pulmonary emboli. Mild to moderate coronary artery calcifications. Small paraesophageal nodes are unchanged.LIVER, BILIARY TRACT: Stable hepatic cysts. No hematoma identified status post biopsy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydronephrosis. No focal renal lesions.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcifications of the aorta and its branches. Single mildly Enlarged left periaortic node measures 1.9 x 1.3 cm (3/85), previously 1.8 x 1.3 cm. No other enlarged lymph nodes seen.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Mild degenerative changes of the visualized spine.OTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: Enlarged prostate. Fat-containing inguinal hernias.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No hepatic hematoma status post biopsy.2.Increased small right pleural effusion with new right basilar opacities which likely represent hemorrhage/infarction related to patient's known pulmonary emboli.3.Single mildly enlarged retroperitoneal lymph node stable in size.. |
Generate impression based on findings. | Reason: hx of bladder cancer s/p cystectomy, on recent surveillance imaging 1cm nodule was noticed, please evaluate History: see above LUNGS AND PLEURA: Previously described left lower lobe pulmonary nodule measures 7 x 5 mm (series 4, image 61), previously measuring 10 mm, decreased in size and likely post inflammatory in etiology.An additional right upper lobe nodule measures approximately 5 mm (series 4, image 38). Additional scattered benign appearing micronodules.No focal air space consolidations. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. No visible coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative disease of the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Subcentimeter hepatic hypodensity is stable, likely a benign cyst. | 1. Previously described left lower lobe pulmonary nodule is decreased in size and likely post inflammatory in etiology.2. Multiple additional scattered micronodules, likely benign. Continued followup as per surveillance protocol. |
Generate impression based on findings. | History of LVAD, pulmonary fibrosis, repeat CT. LUNGS AND PLEURA: Interval decrease in groundglass opacities in the upper lung zones consistent with resolved edema.Moderate upper lobe predominant centrilobular and paraseptal emphysema. There remains basilar groundglass opacities that likely represent edema. This is on a background of increased basilar reticular opacities with associated mild bronchiectasis suggestive of a component of interstitial fibrosis. No pleural effusion.MEDIASTINUM AND HILA: Stable nonspecific enlargement of multiple mediastinal lymph nodes. Calcified mediastinal and hilar lymph nodes consistent with healed granulomatous disease.LVAD and ICD leads, unchanged.Severe cardiomegaly without a pericardial effusion.Severe coronary artery calcification.CHEST WALL: Status-post median sternotomy with nonunion of the sternal fragments.ICD generator in the left anterior chest wall. Abandoned pacemaker leads in the right anterior chest wall.Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Interval decreased pulmonary edema with some residual edema in the lower zones. This is superimposed on a background of basilar mild bronchiectasis and increased reticular opacities suggestive of a component of underlying interstitial fibrosis. |
Generate impression based on findings. | Ms. Goldberg is a 74 year old female with a personal history of left breast partial mastectomy March 2014 for DCIS with microinvasion status post radiation therapy. She has no current breast related complaints. Three standard views of both breasts, left, laterally exaggerated CC view, and two left spot magnification views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the left breast. There are expected postsurgical changes including architectural distortion, increased density, and surgical clips present within the left lumpectomy site. Scattered benign calcifications, including arterial calcifications, are present bilaterally. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | 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. | Female 66 years old Reason: Evaluate for any changes in foci noted on last CT History: Cirrhosis/evaluate for any suspicious lesions 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: Cirrhotic liver morphology . Multiple, stable subcentimeter ill-defined hypoattenuating foci without enhancement. Hepatic vasculature enhances normally with no evidence of thrombus.No biliary dilatation.SPLEEN: Splenic size at the upper limit of normal measuring 12.2 cm in the oblique dimension (series 80868, image 58), unchanged.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Cirrhotic liver morphology with multiple, stable bilobar subcentimeter hypoattenuating foci which do not meet criteria for hepatocellular carcinoma. Hepatic vasculature is patent without ascites or varices. |
Generate impression based on findings. | Ovarian malignancy CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Stable spiculated left breast lesion best seen on image 44 series 3 measuring 1.4 x 1.1 cm.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stable omental metastatic deposits. Left omental reference lesion best seen on image 114 measures 1.4 x 1.9 cm.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus absent or atrophicBLADDER: 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. | Stable examination. |
Generate impression based on findings. | 36-year-old male with ileostomy and mucous fistula of distal bowel for evaluation of distal bowel prior to takedown. Contrast flowed freely from the rectum to the distal third of the transverse colon, emptying from the mucus fistula. Residual, mobile debris was noted in the colon without evidence of obstructing or constricting lesions. This examination is not sensitive for the detection of polyps. Within this limitation, the colonic mucosa is normal in appearance with no evidence of polyps, ulceration, edema, or mass lesions. No significant tortuosity or redundancy of the colon is noted.TOTAL FLUOROSCOPY TIME: 2:56 minutes | Limited water soluble contrast exam. Grossly normal appearing colon up to level of mucous fistula/distal third of transverse colon. |
Generate impression based on findings. | 64 years, Male, Reason: DUODENAL CANCER WITH LIVER METS. EVALUATE FOR INTERVAL CHANGE History: Ampullary adenocarcinoma status post Whipple procedure. CHEST:LUNGS AND PLEURA: Nodule along the minor fissure measuring 1.7 x 1.5 cm ( 5/50) is new from the prior exam. There is an additional left lower lobe nodule which is also new as well as scattered smaller nodules. Ill-defined clustered opacities are present in the right lung base may represent aspiration/infection with a new small right pleural effusion.MEDIASTINUM AND HILA: Enlarged subcarinal nodes measuring 2.7 x 1.4 cm (3/42), previously 1.4 x 0.5 cm. Additional enlarged precarinal node is increased from the prior exam. Heart size is normal with trace pericardial effusion. Mild coronary artery calcifications.CHEST WALL: No axillary lymphadenopathy. Interval removal of malpositioned PICC line.ABDOMEN:LIVER, BILIARY TRACT: Postsurgical changes of Whipple procedure.Large right hepatic lobe lesion is increased in size measuring 8.4 x 7.5 cm (3/68), previously 3.5 x 3 cm. There is an additional subcapsular water density collection along the posterior right hepatic lobe (3/93) of uncertain etiology and significance.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Bilateral adrenal thickening.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Retroperitoneal lymphadenopathy is increased with a reference node measuring 3.0 x 2.0 cm (3/105), previously 1.6 x 1.0 cm. Multiple additional retroperitoneal nodes are increased. BOWEL, MESENTERY: Mild to moderate mesenteric haziness and stranding with scattered small mesenteric nodes is unchanged. Small left fat containing spigelian hernia is unchanged.BONES, SOFT TISSUES: Anasarca.OTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted.LYMPH NODES: Pelvic lymphadenopathy is stable with a right external iliac node measuring 3.0 x 2.0 cm (3/69), previously 3.1 x 2.0 cm. Reference right obturator node measures 4.2 x 2.0 cm (3/176), previously 4.0 x 1.6 cm. Enlarged inguinal nodes are unchanged with a right inguinal node measuring 2.0 x 1.5 cm, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Osteopenia and moderate degenerative changes of the visualized spine.OTHER: Small amount of pelvic ascites is slightly improved. | 1.Progression of disease with increased mediastinal and retroperitoneal lymphadenopathy as well as increased hepatic metastases and new pulmonary metastases.2.New small right pleural effusion and right basilar opacities which likely represent aspiration/infection. |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.