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Generate impression based on findings. | Reason: Stroke activations History: Above, slurred speech The CSF spaces are appropriate for the patient's stated age with no midline shift. Periventricular and subcortical white matter hypodensities of a moderate degree are present. A small hypodense focus is present in the basal ganglia. These are unchanged since the prior examNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Atherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the distal vertebral arteries.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction.3.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 4.Old lacunar infarct in the right basal ganglia. |
Generate impression based on findings. | Male 72 years old; Reason: lumbar pain Moderate dextroscoliosis of the lumbar spine. Moderate facet hypertrophy. Grade 1 anterolisthesis of L4 on L5 with mild narrowing of the disk space. No fracture is present. | Degenerative changes, as above. |
Generate impression based on findings. | Exam is limited due to lack of contrast. Again noted is diffuse destruction and replacement of the L1-2 disk space with T2 hyperintense signal, although slightly decreased in confluence and thickness, along with destruction of the adjacent endplates and significant collapse of the L1 greater than L2 vertebral body. Overall, the extent of abnormal STIR hyperintensity posterior L1 vertebral body appears decreased. The degree of moderate retropulsion appears similar to the L1 level, with moderate narrowing of the canal. There is decreased extent of inflammatory changes along the ventral epidural space previously measured 4 mm in greatest thickness on sagittal images, now measuring 2 mm. No other worrisome marrow signal is appreciated. No large facet effusions are identified to suggest overt septic arthritis.There remains involvement of both psoas muscles by inflammatory changes. The loculated collections within the right psoas muscle are slightly further decreased, with overall expansion of the right psoas measuring 5.8 x 5.7 cm on 1101/25, compared to previous 5.8 x 6.4 cm. There is also been interval further contraction of focal collections within the left psoas. Additional abnormal signal is again seen right paraspinal musculature additional abnormal signal within the overlying subcutaneous fat which may in part relate to edema. The iliacus muscles also demonstrate diffuse abnormal signal, greater on the right side.The lumbar spine is in stable alignment. The vertebral body and disk heights are otherwise well-maintained. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level.Previously described spondylotic changes appear similar. Small amount of focal epidural fat incidentally noted along the right lateral aspect of the thecal sac at the L3-4 level.There are innumerable T2 hyperintense cysts throughout both atrophic kidneys. | 1. Expected evolution of diskitis osteomyelitis at L1-L2 level with slight decreased associated marrow edema and decreased confluence of fluid signal within the disk space. Stable extent of collapse of the L1 greater than L2 vertebral bodies. Slight decreased ventral epidural component of inflammatory changes, with persistent moderate central spinal canal stenosis.2. Slightly decreased edema and central loculated collections within the right greater than left psoas muscles, with additional abnormal signal involving the iliacus muscles and dorsal right paraspinal muscles. |
Generate impression based on findings. | Male 14 months old Reason: abnormal lung exam (crackles), evaluating for heart size, edema, and airway bronchiectasis History: repeated respiratory exacerbationsVIEWS: Chest AP/lateral (two views) 2/17/15 at 1404 hrs. Cardiac silhouette size is normal. Peribronchial thickening, and subsegmental atelectasis of the posterior segment of the right upper lobe with no effusions or pneumothorax. | Bronchiolitis with superimposed subsegmental atelectasis of the posterior segment of the right upper lobe. |
Generate impression based on findings. | Ms. Smith is a 58 year old female with a personal history of left breast mastectomy in 2005 with IDC followed by chemotherapy and radiation. Family history of breast cancer in sister, diagnosed at the age of 49. She has no current breast related complaints. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Scattered benign calcifications, including dermal calcifications are present. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 29 year-old female with colon cancer status post hepatic resection and primary resection of tumor. Evaluate for recurrence. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right chest catheter tip of catheter near the cavoatrial junction. No other abnormality seen.ABDOMEN:LIVER, BILIARY TRACT: Status post right hepatectomy in vena cava stent unchanged in position and appearance. Multiple small hypodense lesions are now seen throughout the liver most of which are peripheral and subcapsular. While these are nonspecific and can be seen with right abnormalities including infection and rare peripheral infarcts, these are certainly worrisome for metastatic disease. Potential reference lesions include Dome of the liver (series 3, image 73 were lesion measures 0.8 x 0.6 cm. peripheral segments subcapsular lesion (series 3 and image 93) measures 1.4 x 1.8 cm.Patient is status post cholecystectomy. No evidence of intrahepatic or extrahepatic biliary duct dilatation is seen to suggest other abnormality. SPLEEN: Mild splenomegaly unchanged without focal abnormality.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Inferior vena cava filter unchanged in position with expected appearance. No other significant abnormality noted. No adenopathy.BOWEL, MESENTERY: Stomach and small bowel appear normal with no evidence of obstruction or intrinsic abnormality with rapid progression of orally administered contrast through to the ileosigmoid anastomosis, status post subtotal colectomy. No free peritoneal fluid.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: Small bowel appears normal with no evidence of obstruction or intrinsic abnormality with rapid progression of orally administered contrast through to the ileosigmoid anastomosis, status post subtotal colectomy. No free peritoneal fluid.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Multiple small diffuse hepatic nonspecific lesions but certainly worrisome for metastatic disease in patient with prior right hepatectomy. 2 status post subtotal colectomy with normal-appearing postoperative changes in the intestinal tract. |
Generate impression based on findings. | Male 63 years old Reason: Evaluate s/p Lt TKA History: Evaluate s/p Lt TKA. Components of a total knee arthroplasty device are situated in near anatomic alignment without radiographic evidence of complication. Skin staples, a drain, and foci of gas in the soft tissues reflect recent surgery. | Total knee arthroplasty. |
Generate impression based on findings. | 42 years, Female. Reason: Dobbhoff placement History: Dobbhoff placement Left basilar opacity. Dobbhoff tip projects over the gastric body. Left chest tube and right central venous catheter are noted. Nonspecific bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | Dobbhoff tip projects over the gastric body. |
Generate impression based on findings. | Female 38 years old; Reason: h/o T cell Rich B Cell Lymphoma with associated HLH s/p 6 cycles of R CHOEP in need of end of treatment staging. Please compare to prior. History: T cell Rich B Cell Lymphoma and HLH s/p 6 cycles of R CHOEP CHEST:LUNGS AND PLEURA: No focal pulmonary lesion. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion.Right chest wall port terminates in the right atrium.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Previously seen hypodense hepatic lesions have mostly resolved. Hepatic and portal veins are patent.There are gallstones. SPLEEN: Hypodense splenic lesion measures 1.4 x 1.3 cm (image 82/series 701) previously, 1.7 x 1.6 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Reference left para-aortic lymph node measures 1.3 x 1.2 cm (image 123/series 701) previously, 2.1 x 1.6 cm.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: Right pelvic lymph node measures 4.3 x 2.9 cm (image 185/series 701) previously, 5.8 x 3.7 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Decrease in the size of the reference lymph nodes. Please see PET portion of the exam for metabolic activity. |
Generate impression based on findings. | 69 year old female with constipation and nausea, evaluate for small bowel obstruction. ABDOMEN:LUNG BASES: Mild basilar atelectasis. Multiple pneumatoceles.LIVER, BILIARY TRACT: Scattered subcentimeter low-attenuation hepatic lesions too small to characterize but likely benign.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple left renal simple cysts. No hydronephrosis or obstructing calculi.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcifications affect the abdominal aorta and its branches. There is mild ectasia of the infrarenal abdominal aorta (series 3, image 87) measuring up to 2.2 x 2.1 cm. There is also mild ectasia of the bilateral common iliac arteries.BOWEL, MESENTERY: Normal caliber small bowel without evidence of obstruction. Appendix well visualized and unremarkable. No intraperitoneal free air or free fluid.BONES, SOFT TISSUES: Degenerative changes of the visualized thoracolumbar spine including moderate-severe degenerative disk disease at L4-S1. Probable bone island in T10 vertebral body.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal caliber small bowel without evidence of obstruction. Appendix well visualized and unremarkable. No intraperitoneal free air or free fluid.BONES, SOFT TISSUES: Degenerative changes of the visualized thoracolumbar spine including moderate-severe degenerative disk disease at L4-S1. Probable bone island in T10 vertebral body.OTHER: No significant abnormality noted | 1.No evidence of bowel obstruction or other specific findings to account for patient's pain.2.Mild ectasia of the infrarenal abdominal aorta measuring up to 2.2 x 2.1 cm. |
Generate impression based on findings. | Left temporal lobe lesion. Portable CT surgery scan. Examination is obtained for operative planning and intraoperative navigation. Surgical frame in place.Streak artifact limits evaluation. Left temporal lesion extending into the left insula and left thalamus much better assessed on prior MRI. No significant intracranial mass effect is evident. No hydrocephalus or extra-axial fluid collections. | Examination for operative planning and intraoperative navigation. Left temporal lesion extending into the left insula and left thalamus much better assessed on prior MRI. |
Generate impression based on findings. | Osteosarcoma. Evaluate for progression of lung nodules. LUNGS AND PLEURA: Post-surgical changes of left wedge resections.Multiple upper lung zone predominant small groundglass nodules, not significantly changed from 2012. Solid micronodules are not significantly changed from immediate prior exam.Left apical reference solid nodule is 3 mm (series 5, image 11), previously 4 mm on 9/2014 CT and not seen on older exams. Left apical groundglass reference nodule is 8 mm (series 5, image 13), unchanged.MEDIASTINUM AND HILA: Densely calcified mediastinal lymph nodes, unchanged.Normal heart size without pericardial effusion.Mild coronary artery calcification.CHEST WALL: Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Bilateral renal cysts. Calcification at the portal hilum, unchanged. | Stable small solid and groundglass nodules. No new sites of disease identified. |
Generate impression based on findings. | 3-year-old female with foot painVIEWS: Left foot, AP and lateral (two views) 2/17/15 14:28 Alignment is anatomic. The osseous structures appear normal for the patient's age. | Normal examination. |
Generate impression based on findings. | Clinical question: intra operative head ct. Signs and Symptoms: same. Nonenhanced head CT:This is a surgical/treatment planning exam and not a diagnostic test.Examination is performed while a stereotactic device is secured to the calvarium without detectable complication.There is revisualization of a cavum septum pellucidum and vergae, Mildly larger tip of the right anterior temporal horn similar to prior exam, stable normal size of the ventricular system otherwise and with maintained mid line.No gross intracranial abnormality is identified. Unremarkable orbits, paranasal sinuses and the mastoid air cells. Calvarium and soft tissues of the scalp are unremarkable. | Treatment/surgical planning nonenhanced head CT as detailed. |
Generate impression based on findings. | Female 39 years old Reason: r/o renal stone History: LLQ pain, hematuria, no signs of infection on UA ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydronephrosis or hydroureter. No findings to suggest a recently passed renal calculus.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Round, hyperdense focus consistent with calcification just posterior to the boundary of the left distal ureter measuring up to 4 mm (series 3, image 115). Favor phlebolith. Trace free fluid in the pelvic cul-de-sac may be physiologic (series 3, image 114). | Calcification in the left lower quadrant without findings suggestive of a recently passed stone favored to be a phlebolith. Trace free fluid in the pelvic cul-de-sac may be physiologic. |
Generate impression based on findings. | Reason: L pleural effusion ?loculations ?underlying mass. pancreatitis, eval for complications History: see above CHEST:LUNGS AND PLEURA: Moderate centrilobular and paraseptal emphysema.No suspicious pulmonary nodules or masses. Small loculated pleural effusions, left greater than right.Scattered bibasilar ground glass opacity and consolidation, left greater than right. Left lower lobe bronchus is filled with debris (series 8, image 60). No underlying mass lesion is seen on noncontrast imaging.MEDIASTINUM AND HILA: The heart is mildly enlarged, without pericardial effusion. Severe coronary artery calcification.No mediastinal or hilar lymphadenopathy.Patulous, fluid-filled esophagusCHEST WALL: Degenerative disease of the thoracic spine.ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: The spleen is displaced medially by surrounding large loculated low density fluid collection.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: There is large mass effect on the pancreas from an adjacent large low-density fluid collection along its anterior aspect.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Significant mass effect on and anterior displacement of the stomach by the large peripancreatic loculated fluid collection.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Large peripancreatic and peri-splenic loculated low density fluid collections likely related to known acute pancreatitis. These collections cause significant mass effect on the spleen, pancreas, and stomach.2. Debris within the left lower lobe bronchus and patchy areas of bibasilar consolidation and scarring, likely related to acute on chronic aspiration; the dilated esophagus likely is a dysmotility disorder.3. Small effusions, left greater than right may be related to aspiration or acute pancreatitis |
Generate impression based on findings. | 2-year-old female with coughVIEWS: Chest AP/lateral (two views) 2/17/15 14:27 The cardiothymic silhouette is normal. The cardiac apex, aortic arch and stomach are left-sided. Bronchial wall thickening and large lung volumes with right middle lobe subsegmental atelectasis. No consolidation or pleural effusions. | Bronchiolitis without evidence of pneumonia. |
Generate impression based on findings. | Respiratory distress on BIPAP secondary to obstructive lung mass. Examination prior to chemotherapy. 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 within normal limits for age without evidence of hydrocephalus. No extra-axial collections. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter which are nonspecific but favored to represent chronic small vessel ischemic changes. Prominent vascular calcification involving the cavernous and supraclinoid internal carotid arteries.There is opacification of the left sphenoid sinus. The visualized portions of the paranasal sinuses are otherwise clear. Mastoid air cells are clear. Calvarium is intact. | 1. No evidence of intracranial hemorrhage or mass effect. If there is significant suspicion for metastatic disease suggest MRI brain with contrast.2. Scattered areas of hypoattenuation in the periventricular and subcortical white matter are nonspecific but favored to represent chronic small vessel ischemic changes. |
Generate impression based on findings. | Female 38 years old; Reason: assess for metastatic cervical cancer History: none ABDOMEN:LUNG BASES: No significant abnormality noted.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: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Contraceptive device is present within the uterus. Left ovary with likely follicle is located adjacent to the left pelvic sidewall on image 105/series 502.BLADDER: No significant abnormality noted.LYMPH NODES: No definite pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No CT evidence of metastatic disease in the abdomen or pelvis.2.Soft tissue adjacent to the left external iliac artery likely represents the patient's left ovary. |
Generate impression based on findings. | 78-year-old male with urothelial cancer, evaluate for recurrence. CHEST:LUNGS AND PLEURA: No significant abnormality seen.MEDIASTINUM AND HILA: No adenopathy. Diffuse coronary artery calcifications. Heart size is normal without pericardial effusions. Mitral valve anulus calcification. CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted. The density presumably cysts in the upper liver are unchanged and the small hemangioma in the inferior right lobe of the liver (series 6, image 103) is unchanged. Gallbladder and biliary tract appear normal.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right kidney again shows large simple cyst without significant abnormality. Left kidney shows cortical scarring with calcification unchanged. No other parenchymal abnormality is seen. Nephroureteral stent is seen exiting through the urinary conduit diversion in the right lower quadrant and similar appearance to prior examination. Prompt and symmetric excretion of contrast material is seen in normal-appearing pyelocalyceal systems bilaterally. No evidence of hydronephrosis. Right ureter is seen in its entirety through to the urinary conduit without abnormality. The stent occupies the diameter of the left ureter.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes seen in from prior conduit urinary diversion. No other significant abnormalities seen.BONES, SOFT TISSUES: Increasing sclerosis is seen in the compression deformity of the T12 vertebral body other compression deformities appear relatively unchanged in the lower thoracic and lumbar spine with moderately severe degenerative disk disease. Degenerative joint disease is seen posterior in the facet joints which does narrow the spinal canal significantly (series 6, image 135). OTHER: No significant abnormality notedPELVIS: PROSTATE, SEMINAL VESICLES: Prior cystoprostatectomy BLADDER: Prior cystoprostatectomy.LYMPH NODES: No adenopathy seen and loculated fluid collection along left external iliac chain (series 3, image 102) is unchanged in size and appearance and most likely represents a lymphocele.BOWEL, MESENTERY: Right inguinal hernia containing small bowel without complication. No free mesenteric fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Status post cystoprostatectomy without evidence of recurrent or metastatic disease and numeral and right lower quadrant ileal conduit urinary diversion with a left nephroureteral stent in stable position into the ileal conduit. 3. Presumed lymphocele in left pelvis stable and unchanged. 4. Moderately severe degenerative disk and degenerative joint disease throughout the thoracolumbar spine. Marked narrowing of the spinal canal is seen at several levels suggesting spinal stenosis. 5. Right inguinal hernia containing small bowel without complication.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 70 year old with history of DCIS status post left lumpectomy. Two standard and two implant displaced 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. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Bilateral retropectoral saline implants are unchanged in position and contour. Linear marker was placed on a scar overlying the left breast, with associated underlying postsurgical distortion. An asymmetry in the right upper breast does not appear significantly changed compared to multiple prior studies. | 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 67 years old; Reason: History of prostate cancer now with biochemical failure. Please evaluate for distant disease/lymphadenopathy. History: biochemical recurrence of prostate cancer CHEST:LUNGS AND PLEURA: No suspicious pulmonary lesions. Pleural spaces are clear.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: Right pelvic sidewall fluid fluid attenuating lesion likely represent is a lymphocele. No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No lymphadenopathy.2.No suspicious sclerotic or lytic lesions. Please see same day nuclear medicine examination to better evaluate the osseous structures. |
Generate impression based on findings. | Female 83 years old Reason: rule out broken ribs History: fell a few months ago and has consistent pleuritic chest pain. Radiopaque markers were placed along the right rib cage. We see no fracture or other specific findings to account for the patient's chest pain. There are wires and plates affixing the sternum. Wires overlying the diaphragm and lower cardiac silhouette may represent retained epicardial pacing leads.There is mild dextroscoliosis of the thoracic spine. Osteoarthritis affects both shoulders with high riding humeral heads bilaterally, likely representing rotator cuff tears. A cluster of round calcifications in the right hemiabdomen likely represents gallstones.Please refer to same day chest radiograph report for information regarding the lungs. | No rib fracture or other specific findings to account for patient's chest pain. Other findings as described above. |
Generate impression based on findings. | Clinical question: Evaluate for intracranial hemorrhage? Signs and symptoms: Poor mental status following cardiac arrest. Portable nonenhanced head CT:Examination is severely limited due to portable technique. Images through posterior fossa are nearly nondiagnostic. Within this limitation however the fourth ventricle is identified with a normal size and in midline.Images supratentorial space demonstrate near complete effacement of gray -- white matter differentiation, well demarcated foci of bilateral symmetrical low attenuation of basal ganglia, regions of well demarcated low attenuation in bilateral occipital lobes (left greater than right), effacement of all cortical sulci, small size of lateral ventricles and small size of CSF cisterns. Findings are all suggestive of extensive global ischemic changes and cerebral edema. There is no detectable hemorrhage or deviation of midline.Findings and concerns on this exam were discussed by phone with the referring clinical service Dr, Joseph Venturi pager # 3691 at the time of review of exam. | Extensive cerebral edema with resultant complete effacement of gray -- white matter differentiation, effacement of the cortical sulci and regions of hypoxic change in bilateral basal ganglia, bilateral occipital lobes. |
Generate impression based on findings. | 11 year old female, postop evaluationVIEWS: Lower extremity scanogram, left tibia and fibula, AP and lateral (two views) 2/17/15 14:42 The right femur measures 47 cm in length and the left measures 44 cm. The right tibia measures 38 cm in length and the left measures 43 cm. The right total leg length is 85 cm and the left is 87 cm.Tibia/fibula: External fixation device affixes the tibial osteotomy, with mild lateral displacement of the distal fracture fragment. Bridging callus formation is slightly increased from the prior exam. | External fixation of left tibial osteotomy as described above without evidence of hardware complication. |
Generate impression based on findings. | 43 year old woman with history of abnormal mammogram and ultrasound of the right breast. Right ultrasound re-identified the target lesion for biopsy. The lesion to be targeted is a poorly-defined hypoechoic mass measuring over 3 x 2.3 cm with numerous internal calcifications at the 11 o’clock position with increased vascularity, 4 cm from the nipple. This lesion was readily visible.As the outside ultrasound study visualized a benign-appearing mass at 7:30 position, focused ultrasound was performed. The same "lesion" was detected, but this is a pseudolesion which appears to be comprised of a small cyst adjacent to normal appearing breast tissue. Ultrasound also identified two abnormal lymph nodes in the right axilla. One lymph node has diffusely thickened cortex, and the other has asymmetric cortical thickening. Both lymph nodes show abnormal non-hilar blood flow. It is decided to target the lymph node with diffuse cortical thickening. Bipolar maximum dimension of the targeted lymph node was 1.2 cm, cortical thickness was 0.5 cm, and marked non-hilar cortical blood flow was seen on color flow imaging. The target node was readily visible.PROCEDURE: The procedure and its risks, including bleeding, infection, and failure to diagnose, and expected benefits of ultrasound-guided core biopsy with percutaneous placement of a marking clip and post-procedure unilateral mammogram were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time-out form was completed to confirm patient identity and side/type of procedure.The right breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially, with 1% lidocaine with 1:100,000 epinephrine at depth. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and a inferior to superior approach, three 12-gauge core needle (Celero) specimens were obtained of the lesion. Targeting was judged very good. All specimens sank to the bottom of the prefilled container of 10% formalin. Specimen quality was judged very good.The right axilla was cleansed with chlorhexidine over the target area. A 3 mm incision was made in the skin with a #11 scalpel blade. Using aseptic technique, continuous ultrasound guidance and medial to lateral approach, a 14-gauge core needle (InRad) was directed into the target node and four specimens were obtained. Samples were obtained through the peripheral cortex of the lymph node. Targeting was judged very good. Two specimens sank to the bottom of the prefilled container of 10% formalin and two specimens partially sank. Specimen quality was judged good. Whitish tissue was noted in several specimens.Specimens were sent to Pathology with an accompanying history sheet. Using continuous ultrasound-guidance a Hydromark clip was placed into both the breast lesion and the axillary lymph node in the usual manner. Pressure was held over the biopsy site until all bleeding subsided. The skin incisions were closed with a Steri-Strip. Post-procedure digital right CC and ML views revealed the percutaneously placed clip to be in the expected location in the central aspect of the clustered calcifications. The axillary lymph node was not seen on these views. No evidence of hematoma or other complication.A pressure dressing was positioned over the biopsy site and an ice pack positioned over the pressure dressing. Post-procedure instructions were reviewed with the patient both verbally and in writing. She tolerated the procedure well with no evident complications and proceeded to stereotactic biopsy in stable condition.The procedure was performed by Drs. Abe and Patel. Dr. Abe was present during the procedure at all times. | 1. Successful ultrasound-guided core biopsy of the right breast lesion and clip placement. Pathology is pending at this time.2. Successful ultrasound guided core biopsy of an abnormal right axillary lymph node. Pathology is pending at this time.3. A benign appearing lesion at 7:30 position in the right breast on outside ultrasound was a pseudolesion comprised of cyst and fat lobule.BIRADS: 5 - Highly suggestive of malignancy.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | 1 year old female with history of cloaca and constipation. Evaluate degree of stool burden. VIEW: Abdomen AP (one view) 2/17/2015 15:06 Nonspecific bowel gas pattern with no definite evidence of obstruction. Average stool burden. Again seen are vertebral body deformities and malformations including fusion defect of the lower lumbar spine and partial sacral agenesis. Bifid right 10th and11th ribs. | Nonspecific bowel gas pattern with no definite evidence of obstruction. Average stool burden. |
Generate impression based on findings. | 41 years old male with a history of melanoma, s/p wide local excision of melanoma and sentinel lymph node biopsy which was positive. Please evaluate for extent of disease and metastasis. RADIOPHARMACEUTICAL: 10.0 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 101 mg/dL. Today's CT portion grossly demonstrates multiple small lymph nodes in the neck and bilateral axillary regions.Today's PET examination demonstrates several small foci of increased activity in the left cervical normal-sized lymph nodes at left level 2 region with SUV Max of 2.4. There is also a small focus of increased activity in the right level 2 lymph node with SUV Max of 2.1. Mild FDG uptake is seen in several normal sized lymph nodes in the bilateral axillary regions with SUVmax in the left axillary lymph nodes of 1.8.There is a small focus of increased activity with SUVmax of 4.9 in the right abdomen at the hepatic flexure of the colon without definite CT correlation. There is a focus of increased activity in the skin of right medial distal thigh with SUVmax of 1.4.Diffuse FDG uptake is seen in the right knee and both shoulders, which is consistent with arthritis.Physiological activity is seen in the left, spleen, kidneys, intestines and bladder. | 1.Small mild hypermetabolic lymph nodes in the neck and the bilateral axillary regions, which are nonspecific.2.Focus of increased activity in the hepatic flexure of the colon without definite CT correlation, which can be due to diverticulitis, adenoma or carcinoma. Suggest further evaluation of coloscopy.3.Nonspecific focal skin uptake in the right medial distal thigh. |
Generate impression based on findings. | Two year old female with history of fractureVIEWS: Left forearm AP and lateral (two views) 2/17/15 15:13 A cast is again seen which obscures fine bone detail. Healing fractures of distal radius and ulna with persistent dorsal angulation of the distal radial fracture fragment. | Healing distal forearm fractures with persistent dorsal angulation of the distal radial fracture fragment. |
Generate impression based on findings. | Reason: thoracic aneurysm History: same LUNGS AND PLEURA: Subpleural interstitial opacity in the right upper lobe suggestive of fibrosis, unchanged.Triangular 5-mm solid nodule in the right middle lobe adjacent to major fissure, new since the previous scan and suggestive of an intrapulmonary lymph node (series 5/62).MEDIASTINUM AND HILA: Mildly enlarged mediastinal lymph nodes, unchanged from previous, likely reactive.Severe coronary artery calcification.Resolution of previous small pericardial effusion.Descending thoracic aorta aneurysm, measuring 70mm in diameter, slightly increased from 66 mm previously on the axial sections but unchanged on the coronal sections..In the absence of contrast material possible intramural hematoma or ulceration cannot be evaluated.CHEST WALL: Masslike left subpectoral fluid collection measuring 55 x 31 mm, slightly increased from 32 x 48 mm, though the difference is not necessarily significant due to changes in position. Small amounts of calcification are present in the periphery of this mass.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Status post cholecystectomy. | Slight increase in axial diameter of thoracic aortic aneurysm. |
Generate impression based on findings. | Female 72 years old Reason: dropped skillet on foot yesterday History: dropped skillet on foot yesterday. The bones are demineralized, suggesting osteopenia/osteoporosis. We see no fracture. Mild to moderate osteoarthritis affects the first metatarsophalangeal joint. A small ossicle in the soft tissues medial to the first metatarsal head may reflect old trauma, but does not appear to be an acute fracture fragment. | Demineralized bones without fracture. |
Generate impression based on findings. | 66-year-old male with history of metastatic gastric cancer now with abdominal pain, evaluate for bowel obstruction and evaluate stent. ABDOMEN:LUNG BASES: Mild basilar atelectasis.LIVER, BILIARY TRACT: Mild intrahepatic biliary ductal dilatation appearing similar to prior. The common bile duct is again dilated duct until the level of the duodenum. The portal vein is patent. There is mild nonspecific gallbladder wall thickening appearing similar to prior. SPLEEN: No significant abnormality notedPANCREAS: The pancreatic duct is dilated up to 7 mm.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral renal cysts. No hydronephrosis or nephrolithiasisRETROPERITONEUM, LYMPH NODES: Reference upper abdominal lymph node adjacent to the portal vein (series 3, image 29) measures 2.1 x 3.8 cm, measured 2.4 x 2.4 cm previously.BOWEL, MESENTERY: Gastroduodenal stent is in place appearing similar to prior. Its distal portion impresses upon the IVC and aorta. Soft tissue mass about the duodenum (series 3, image 36) likely represents a necrotic lymph node measuring 4.1 x 3.2 cm, measured 3.5 x 3.4 cm previously.The larger component of the previously described bilobed mass (series 3, image 53) measures 4.7 x 5.0 cm, measured 4.7 x 5.5 cm previously. There is infiltration of the fat planes in the upper abdomen. Extensive peritoneal and omental thickening in the region indicative of omental disease. There is small amount of ascites in the upper abdomen. There is some mesenteric edema in the upper abdomen.Normal caliber small bowel without evidence of obstruction.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: See above. Peritoneal nodularity.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No evidence of small bowel obstruction. 2.Gastroduodenal stent similar to prior. 3.Reference metastatic lesions overall similar to prior. 4.Persistent dilatation of the biliary tree due to partial obstruction near the level of the duodenum. |
Generate impression based on findings. | History of paraganglioma. Evaluate for recurrence. RADIOPHARMACEUTICAL: 11.9 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 88 mg/dL. Today's CT portion grossly demonstrates postsurgical changes in the right neck. The right submandibular gland is surgically absent. A right carotid artery stent is present. Today's PET examination demonstrates no FDG avid tumor within the neck, chest, abdomen, and pelvis. Minimal increased FDG activity around the right carotid stent is likely inflammatory change. | No evidence of FDG avid tumor. |
Generate impression based on findings. | Reason: SOB History: above PULMONARY ARTERIES: No evidence of pulmonary embolism. Anastomosis at the main pulmonary artery from prior cardiac transplant. LUNGS AND PLEURA: No suspicious pulmonary nodules or masses.Mild septal prominence, suggesting pulmonary edema. Moderate pleural effusions, right greater than left, with mild associated compressive atelectasis. Mild basilar subsegmental atelectasis/scarring.MEDIASTINUM AND HILA: Surgical changes of a cardiac transplant. The heart is enlarged, without pericardial effusion. Severe coronary artery calcification.No significant mediastinal or hilar lymphadenopathy.CHEST WALL: Mild degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. The spleen is partially visualized, but appears enlarged, increased from the prior exam dated 01/2006. | 1.No evidence of pulmonary embolism.2.Pulmonary edema and pleural effusions with associated compressive atelectasis. Findings compatible with CHF.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Female 39 years old Reason: pain after fall History: pain, swelling. We see no fracture, malalignment, or joint effusion. No findings to account for patient's pain. | No findings to account for the patient's pain. If there is clinical concern for internal derangement, MRI can be considered. |
Generate impression based on findings. | 12-year-old female with fractureVIEWS: Right ankle AP, oblique, lateral (3 views) 2/17/2015 15:22 Interval removal of cast. Distal fibular physis remains widened with subtle bridging along the lateral aspect. Alignment is anatomic. No soft tissue swelling or joint effusion. | Healing fracture of the distal fibular fracture in anatomic alignment with subtle bridging of the lateral aspect of the fibular physis. |
Generate impression based on findings. | 55-year-old male metastatic lung cancer, liver metastases, status post chemotherapy ABDOMEN:LUNG BASES: See chest CT report for complete examination result and multiple left rib and metastatic lesions are again seen, appearing than previous and with probable additional foci. Nuclear medicine bone scintigraphy is a more accurate indicator of activity with skeletal metastatic disease.LIVER, BILIARY TRACT: Left hepatic lobe metastasis (series 10 , image 24) is increased in size measuring 4.9 x 4 .0 cm, previously 3.3 x 3.0 cm. In addition satellite lesion just adjacent to this has increased in size. No other foci of metastatic disease are seen elsewhere in the liver.Gallbladder and biliary tract show no diagnostic abnormalities -- the prior calcified gallstone is not visible on today's examination in the collapsed gallbladder.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Marked right renal atrophy seen unchanged left kidney shows normal morphology without abnormal mass and no hydronephrosis. Nonobstructing lower pole calyceal stone again identified.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Increasing size and number of lytic lesions focused on the T10 vertebral body when compared with prior examination. Enlarging L. size but body lytic lesion is seen consistent with progression of metastatic disease. Nuclear medicine bone scan is more accurate indicator of activity of skeletal metastatic disease.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: Bilateral inguinal hernias containing only mesenteric fat seen.OTHER: No significant abnormality noted | 1. Increasing size of liver metastatic lesion and adjacent satellite lesion. 2. Increasing size and number of lytic skeletal metastatic lesions as described above. Nuclear medicine is a more sensitive indicator of extent and activity of skeletal metastatic disease. |
Generate impression based on findings. | Clinical question: Evaluate sinuses. Signs and symptoms: Frequent sinusitis without resolution after treatment medically. Ongoing facial pain. Medtronic fusion sinus CT:Frontal sinuses are well pneumatized and unremarkable.Ethmoid sinuses are well pneumatized and unremarkable.Sphenoid sinus is well pneumatized and unremarkable with patent bilateral sphenoethmoidal recesses.Maxillary sinuses are well pneumatized and without evidence of disease. Patent bilateral ostiomeatal units.Nasal passage demonstrate mild rightward nasal septum deviation and a small rightward projecting bony septal spur which is in contact and mildly deforms the right inferior turbinate mucosal. Unremarkable images through the nasal passage otherwise.Bilateral mastoid air cells and middle ear cavities are well pneumatized and unremarkable.Under local images through the orbits and soft tissues are facial region. | 1.No evidence of sinusitis.2.Mild rightward nasal septum deviation, small rightward projecting bony septal spur resulting in mild deformity of the right inferior turbinate mucosa.3.Unremarkable orbits and well pneumatized mastoid air cells and middle ear cavities. |
Generate impression based on findings. | Female; 60 years old. Reason: 60 yo CF with history of mycosis fungoides with left renal exophytic hypoattenuating lesion on CT, further evaluate RIGHT KIDNEY: Right kidney measures 11.5 cm in length. The renal cortex is normal in echogenicity. There is a nonobstructing 6 x 4 x 4 mm renal stone in the inferior pole. There is no hydronephrosis or worrisome renal mass.LEFT KIDNEY: The left kidney measures 10.4 cm in length. There are no cortex is normal in echogenicity. In the lateral aspect of the left kidney is a 1.3 x 1.2 x 1.1 cm minimally complex cyst. There is no hydronephrosis, shadowing renal stone, or worrisome mass identified.URINARY BLADDER: The bladder is nondistended.OTHER: No significant abnormalities noted. | 1.Nonobstructing right renal stone.2.1.3 cm minimally complex left renal cyst. |
Generate impression based on findings. | Female 64 years old Reason: hx of bladder cancer, evaluate for metastatic disease with delayed imaging History: see above ABDOMEN:LUNG BASES: Scattered nonspecific micronodules, unchanged.LIVER, BILIARY TRACT: No evidence of liver metastasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right nonobstructing renal calculus, unchanged.RETROPERITONEUM, LYMPH NODES: Interval increase in multiple retroperitoneal lymph nodes. Reference retroperitoneal lymph node just inferior to the bifurcation of the aorta measures 1.0 x 0.8 cm, previously 0.6 x 0.8 cm (series 6, image 145) Reference left periaortic node is stable in size measuring 1.5 X 0.8 cm, previously 1.5 by 0.8 cm (series 6, image 114).BOWEL, MESENTERY: Unremarkable appearance of the bowel anastomosis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Status post hysterectomy and bilateral salpingo-oophorectomy.BLADDER: Status post cystectomy with ileal conduit formation. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Dramatic interval increase in multiple soft tissue nodules within the pelvis. For reference, an anterior pelvic wall nodule measures 5.7 x 5.4 cm (series 6, image 185), previously 2.0 x 1.7 cm. There is now invasion of the pelvic small bowel with circumferential involvement of bowel loops (series 6, image 178). No small bowel obstruction or intraperitoneal free air.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Dramatic interval increase in multiple pelvic soft tissue nodules consistent with peritoneal tumor deposits. There is now invasion of the pelvic small bowel with circumferential involvement of bowel loops. No small bowel obstruction or intraperitoneal free air.2.Interval increase of multiple retroperitoneal lymph nodes consistent with progression of metastatic disease. |
Generate impression based on findings. | 16-year-old male with a fractureVIEWS: Right ankle AP, oblique, lateral (3 views) to 17/2015 15:30 Interval removal of cast material. A plate and screw device are again seen in the distal fibula with the distal fibular fracture in near-anatomic alignment. No evidence of hardware complication. Periosteal reaction along the distal tibia is again seen. Geographic area of lucency along the medial aspect of the tibial metaphysis and medial malleolus increased from prior study. | 1. Distal fibular and tibial fractures in near anatomic alignment. 2. Area of lucency along the medial aspect of the tibial metaphysis and medial malleolus may represent healing and/or osteonecrosis. |
Generate impression based on findings. | There is again suggestion of slight prominence of the cerebral sulci especially involving the frontal and parietal lobes, as well as supratentorial ventricular prominence. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | No acute intracranial abnormality. Stable nonspecific prominence of cortical sulci and supratentorial ventricular system. If there remains concern for an acute ischemic event, MRI brain is recommended. |
Generate impression based on findings. | Male 62 years old Reason: 62 y/o with neck pain eval acute changes History: neck pain. There are small intercalary osteophytes along the anterior aspect of the spine, but the intervertebral disk spaces are preserved, as are the vertebral body heights. There is perhaps mild multilevel facet joint osteoarthritis, but the neuroforamina are grossly patent. There is no acute abnormality. We see no acute fracture. | Mild degenerative arthritic changes without fracture or other acute abnormality. |
Generate impression based on findings. | 4 year old female with fractureVIEWS: Left humerus AP, lateral (two views) 2/17/15 15:40 Healing proximal humeral fracture with improvement in posterior medial angulation of the distal fracture fragment. Bony remodeling and periosteal reaction is again seen reflecting interval healing. | Healing proximal humeral fracture in near anatomic alignment. |
Generate impression based on findings. | Male 45 years old Reason: ap lateral view History: 1 year post cervical laminoplasty. Patient is status post multilevel laminoplasty. The alignment is within normal limits. There is mild degenerative disk disease at C3/4 and C4/5. The vertebral body heights are preserved. | Postoperative changes of prior laminoplasty and mild degenerative disk disease as described above. |
Generate impression based on findings. | 5-year-old male with foot pain, history of neuroblastomaVIEWS: Left ankle, AP and lateral (two views) left foot, AP, lateral, and oblique (3 views). Ankle: There is moderate soft tissue prominence about the ankle and possible small effusion without underlying osseous abnormality. Alignment is anatomic.Foot: Alignment is anatomic. The osseous structures appear normal for the patient's age. | Soft tissue prominence about the ankle and possible small effusion without osseous abnormality. |
Generate impression based on findings. | Frontal sinus: The frontal sinus and frontoethmoidal recesses are essentially completely opacified except for a small focus of air in the right frontoethmoidal recess.Anterior ethmoids: The anterior ethmoid air cells are near completely opacified, worsened since the prior exam CT.Maxillary sinuses: There is improved aeration of the right maxillary sinus while the left is completely opacified. Soft tissue windows demonstrate central hyperattenuation which likely relate to inspissated secretions. The ostiomeatal units remain opacified bilaterally.Posterior ethmoids: The posterior ethmoid air cells are completely opacified, worsened since prior exam.Sphenoid sinus: The sphenoid sinus and bilateral sphenoethmoidal recesses are completely opacified with significant worsening in the right sphenoid sinus. There is moderate leftward nasal septal deviation. The nasal turbinate morphology largely cannot be assessed secondary to nasal cavity opacification. The right concha bullosa is now opacified. Also polypoid lesions are suggested within the aerated portions of the nasal cavity.The lamina papyracea are intact. The previously noted thinning of the left cribriform plate is less conspicuous on the current exam, with better delineation of the bone along the medial roof of the left ethmoids. On 80384/82, there is a small 2-mm bony defect which appears to remain along the lateral aspect of the ethmoid roof posteriorly. | 1. Worsened pan sinus opacification. High-density material within the central maxillary sinuses likely represents inspissated secretions although superimposed fungal infection cannot be excluded.2. Polypoid opacification of nasal cavity again suggested, which may relate to sinonasal polyposis.3. Improved visualization of the left ethmoid roof in the area previously questioned abnormality, although a small osseous defect remains suggested along the posterior lateral aspect. |
Generate impression based on findings. | Pain. Fall. LEFT KNEE: No fracture or malalignment. Moderate degenerative changes are present, with osteophyte formation. Calcific density within the knee joint likely represents CPPD.RIGHT SHOULDER: There is a comminuted fracture through the distal third of the clavicle with minimal inferior angulation of the distal fracture fragment. The AC joint is intact. No humeral head dislocation is present. No humeral fracture is noted. | Distal clavicular fracture, as above. |
Generate impression based on findings. | 50 year-old female status post video capsule ingestionVIEW: Abdomen AP (one view) 2/17/15 15:37 No radiopaque foreign body or capsule is visualized. The bowel gas pattern is nonobstructive. | No radiopaque foreign body or video capsule visualized. |
Generate impression based on findings. | History of metastatic bone lesions. Evaluate for mets. There are multiple areas of increased radiotracer uptake noted in the right parietal skull, posterior right 7th rib, and thoracic and lumbar spine including the T12 and L4 vertebral bodies. Increased uptake within the cervical and upper thoracic spine likely correlates with spinal fixation hardware. A round area of uptake within the soft tissues of the pelvis likely represents uterine fibroids. There is degenerative uptake within the shoulders and knees. | Multiple areas of increased uptake compatible with osseous metastatic disease. |
Generate impression based on findings. | 24 years, Male, Reason: Bright red blood drainage from urethra and drain bag concern for fistula History: Bright red blood drainage from urethra and drain bag concern for fistula. ABDOMEN:LUNG BASES: Small left pleural effusion with associated compressive atelectasis is unchanged. Central venous catheter tip terminates at the cava atrial junction. Endotracheal tube tip is at the carina.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodularity is unchanged.KIDNEYS, URETERS:There is a right nephroureterostomy tube with pigtails in the right renal pelvis and bladder. There is increased moderate right-sided hydroureteronephrosis with blood filling the calices, renal pelvis right ureter and bladder. There is a more focal hyperdense cortical focus along the course of the catheter which likely represents a pseudoaneurysm. A feeding vessel to this region can be seen on arterial phase images (series 14, images 49 through 53). There are small stones in the lower pole.RETROPERITONEUM, LYMPH NODES: Aorta is small in caliber. The left external iliac artery is ectatic but patent. IVC filter.Interval decrease in organized fluid collection extending from the left paracolic gutter down the left pelvic sidewall and containing a drainage catheter. Small enlarged retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: Multiple large colonic loops as well is mildly dilated small bowel loops, suggestive of ileus.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Blood products within the bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: See above.BONES, SOFT TISSUES: Bilateral hip dysplasia with multilevel fusions of the thoracolumbar spine. Anasarca.OTHER: No significant abnormality noted | 1.Pseudoaneurysm in the right kidney along the course of nephroureterostomy tube with blood within the right renal pelvis, ureter and bladder.2.Left pelvic organized collection is decreased in size.3.Chronic ileus.4.Low lying endotracheal tube.Findings discussed with ICU resident at the time of this dictation. |
Generate impression based on findings. | Status post fracture.VIEWS: Right forearm AP lateral 2/17/15 (two views) Healing fractures of the right radius and ulna with minimal dorsal angulation are unchanged in alignment. | Healing fractures, unchanged in alignment. |
Generate impression based on findings. | Hyperparathyroidism localization. There is physiologic distribution of the radiopharmaceutical. An abnormal focus of increased radiotracer uptake is identified inferior to the lower pole of the right thyroid lobe. This focus washes out on delayed images. The right thyroid lobe appears to measure 4.8 cm and the left lobe 4 cm in length. | Abnormal focus of increased uptake inferior to the lower pole of the right thyroid lobe is highly suspicious for a parathyroid adenoma. |
Generate impression based on findings. | Rule out FAI, CAM Due to technologist error, the knees and pelvis were not scanned, and therefore some of the measurements below cannot be calculated. We will attempt to have the patient return for a complete study, at which time an addendum will be locked.MEASUREMENTS: CAM location : Three o'clock anteriorAlpha angle : 55 degreesCoronal center-edge angle : 37 degrees (uncorrected for pelvic obliquity)Sagittal center-edge angle : 67 degrees (in true sagittal plane, to anterior edge of the acetabulum)Femoral neck-shaft angle : 129 degreesAcetabular version (1 o’clock) : 10 degrees of retroversion (uncorrected for pelvic obliquity)Acetabular version (2 o’clock) : 4 degrees of retroversion (uncorrected for pelvic obliquity)Acetabular version (3 o’clock) : 13 degrees of anteversion (uncorrected for pelvic obliquity)Femoral version angle (+anteverted, -retroverted) : Cannot calculateMcKibbin index : Cannot calculateAIIS width : Approximately 1.5 cmDistal base of AIIS to acetabular rim : Approximately 3 mm | Borderline CAM deformity and other measurements as described above. Please note that this is an incomplete examination and the patient will be asked to return for additional scanning of the pelvis and knees at no charge. |
Generate impression based on findings. | Reason: hx resected squamous cell ca of bladder History: evaluate for metastases LUNGS AND PLEURA: Scattered micronodules, unchanged from previous, most likely post infectious.No suspicious nodules.MEDIASTINUM AND HILA: Mildly enlarged inhomogeneous left lobe of the thyroid gland, unchanged.No significant lymphadenopathy.No visible coronary artery calcification.No pericardial effusion.CHEST WALL: Bifid right fourth rib, and normal variant.Mildly enlarged axillary lymph nodes, unchanged.Moderate degenerative disease in the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. The abdominal portion of the scan will be reported separately. | Stable micronodules and no specific evidence of metastatic disease in the thorax. |
Generate impression based on findings. | Male 6 days old Reason: is PCVC in correct placement? History: PCVC placement, respiratory distress syndrome.VIEW: Chest AP (one view) 2/17/15 at 1612 hrs. ET tube tip is below the thoracic inlet. NG tube terminates at the stomach. Umbilical lines unchanged. Abdominal drain is again present. Cardiac silhouette size is normal. Right knee the lobe ill-defined opacity, likely atelectasis on a background of diffuse lung haziness. Interval improvement in right upper lobe atelectasis. Left upper extremity PCVC terminates at the left axillary/subclavian vein junction. | Not centrally positioning of new PCVC.Interval improvement in right upper lobe atelectasis and development of right middle lobe opacity on a background of diffuse lung haziness. |
Generate impression based on findings. | Worsening reflux symptoms, on EGD large amounts of retained food and liquid despite 8 hrs of fasting. Evaluate for gastroparesis. Visually there was significant delayed gastric emptying. Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:30 mins: 80 % of peak activity (normal >70 %)1 hour: 80 % of peak activity (normal 30-90 %) 2 hours: 79 % of peak activity (normal <60 %) 4 hours: 62 % of peak activity (normal <10 %) | Significantly delayed gastric emptying. |
Generate impression based on findings. | Male 3 years old Reason: Cochlear implant placement History: Post-op cochlear implantVIEWS: Skull AP and lateral 2/17/15 (two views) Interval left cochlear implant placement. The implant does the complete curl of the cochlea. No evidence of kinking or disconnections. | Status post left cochlear implant as described. |
Generate impression based on findings. | Evaluate RML density. CHEST:LUNGS AND PLEURA: Post-surgical findings of right lower lobe wedge resection.Right middle lobe subpleural nodule with adjacent atelectasis is 17 x 12 mm, previously 7 x 6 mm (series 6, image 69).Stable bilateral scattered pulmonary nodules, likely post-inflammatory.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion.Moderate coronary artery calcification.No mediastinal or hilar lymphadenopathy.Ectatic ascending thoracic aorta, unchanged.CHEST WALL: Demineralized bones. Mild to moderate multilevel degenerative disk disease of the thoracolumbar spine. T11 left pedicle and T8 right transverse process lucencies are unchanged. Chronic right rib deformity. ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Punctate scattered hepatic hypodensities, unchanged and likely cysts. Cholecystectomy clips.SPLEEN: Peripherally calcified splenic artery aneurysm in the hilum, unchanged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal cysts, unchanged. Left upper pole renal angiomyolipoma, unchanged. Malrotated right kidney.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Calcified small gastroduodenal artery aneurysm, unchanged. Calcified atherosclerotic disease of the abdominal aorta.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Enlarging right middle lobe nodule with adjacent atelectasis, which may represent a granuloma although a primary lung malignancy is also possible. Short interval follow-up is recommended, alternatively PET-CT may be considered for further evaluation. |
Generate impression based on findings. | Reason: 80 y/o M with PMH of CHF, COPD, thoracic aorta dilation on CXR, please eval for AAA or other lung pathology History: as above CHEST:LUNGS AND PLEURA: Scattered benign-appearing pulmonary micronodules, some calcified. No suspicious pulmonary nodules or masses.Apical pleural scarring. Very small bilateral pleural effusions, right greater than left, with mild compressive atelectasis.MEDIASTINUM AND HILA: The heart is mildly enlarged, with a small pericardial effusion. Severe coronary artery calcification.The ascending and descending thoracic aorta are normal in caliber, stable from prior imaging dated 10/2005.No lymphadenopathy.CHEST WALL: Degenerative disease of the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Subcentimeter hepatic hypodensities, likely simple cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: See bilateral renal hypodensities, likely simple cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: The abdominal aorta is normal in caliber. 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. The thoracic and abdominal aorta are normal in caliber, stable from prior exam dated 10/2005. 2. Small pleural effusions, without other acute cardiopulmonary abnormality. |
Generate impression based on findings. | Reason: mets lung cancer, liver mets. sp chemo, pls c/w previous study and evaluate dx status. History: lung ca LUNGS AND PLEURA: Reference left upper lobe paramediastinal nodule measures 19 x 12 mm (series 9, image 35), unchanged.Left paramediastinal radiation fibrosis, unchanged.Left basilar low density pleural thickening increased, with stable focal areas of nodularity and enhancement (series 9, images 86 and 98), the latter are confluent with adjacent rib metastases and hypermetabolic on previous PET imaging. Mild nodularity along the left major fissure is unchanged.Slight increase in volume of loculated pleural fluid on the left, small.Mild basilar subsegmental atelectasis.Additional scattered benign appearing micronodules, some calcified, are unchanged.The right lung remains clear.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. Mild coronary artery calcification.A small area of focal mediastinal infiltration by the adjacent left paramediastinal nodule (series 7, image 32) appears similar to the prior exam. Nonindex left hilar lymph node measures 7 mm (series 7, image 56), with characteristics suggestive of a metastatic lymph node, not significantly changed from the prior exam. Additional scattered small mediastinal and hilar lymph nodes appear similar to prior exam.CHEST WALL: Lytic lesions in the T5 and T10 vertebral bodies and a left third rib lesion have increased in size from the prior exam. A soft tissue lesion in the left lateral chest wall (series 7, image 98), with associated destruction of the lateral eighth rib, is mildly increased in size from the prior exam. An additional soft tissue lesion with associated lytic component involving the posterior left 11th rib (series 7, image 95) is not significantly changed from the prior exam. Soft tissue mass at the 11/12th rib interspace medially was probably present previously given the benefit of retrospect but better seen on today's study (7/1)Mild left internal mammary chain lymphadenopathy (7/55) appears stable.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. A left hepatic lobe metastatic lesion is increased from the prior exam. Filling defect in the dependent aspect of the stomach is nonspecific. Please see same day CT abdomen pelvis for additional details. | 1.Stable appearance of a left paramediastinal nodule/mass and adjacent post radiation changes.2.Multiple osseous metastatic lesions have increased in size from the prior exam.3.No new pulmonary nodules or masses.4.Subjective increase in left pleural metastatic disease with areas of extension to the chest wall as detailed in the body of the report.5.Abdominal findings will be reported separately |
Generate impression based on findings. | Right breast cancer. Surgery 2/18/2015 at 1 pm by Dr Jaskowiak. Right wire loc lumpectomy, SNBx, CALND, removal of left port in CDOR.RADIOPHARMACEUTICAL: The right breast was prepared in a sterile manner. A total of 1.069 mCi Tc-99m filtered sulfur colloid was injected in four periareolar injections. Foci of increased activity are noted in the right axillary and right internal mammary lymph node stations, representing the sentinel node(s). These regions were marked with an indelible marker. | Sentinel node identified in the right axillary and right internal mammary stations. |
Generate impression based on findings. | Gait difficulty, cogwheeling rigidity. Evaluate for Parkinson's disease. Normal symmetric activity is seen in the basal ganglia. | Normal examination. No evidence of nigrostriatal dopaminergic dysfunction. |
Generate impression based on findings. | The liver is normal echogenicity measuring up to 5.1 cm in length. No intra-or extrahepatic biliary ductal dilatation. The gallbladder is contracted with no evidence of sludge or cholelithiasis. The gallbladder wall measures up to 1 mm in thickness, within normal limits. There is no pericholecystic fluid. The common bile duct measures up to 1 mm in diameter. The pancreas is normal in echogenicity with no evidence of pancreatic ductal dilatation. The spleen is normal echogenicity measuring up to 2.3 cm in length. | Normal examination with no evidence of biliary atresia. Contracted gallbladder with no evidence of sludge or cholelithiasis. |
Generate impression based on findings. | 12 year old female with epigastric and right lower quadrant pain. Evaluate for appendicitis. Visualized structure in the right lower quadrant measures up to 5-6 mm in diameter may represent an appendix, however it is unclear whether this is truly the appendix and therefore study is inconclusive to rule out appendicitis. There is a small amount of free fluid in the lower abdomen. Scattered mildly prominent mesenteric lymph nodes in the periumbilical region. | The appendix is not definitively visualized and study is inconclusive for ruling out appendicitis. There is small amount of free fluid in the lower abdomen. Scattered mildly prominent lymph nodes in the periumbilical region.Findings were discussed with ED physician Dr. Christine Babcock by phone on 2/13/2015 at 10:20 AM. |
Generate impression based on findings. | 7 years old Male. Reason: Post therapy- evaluate uptake. History: Relapsed neuroblastoma s/p MIBG therapy. Extensive bone marrow uptake is in the skeleton including whole spine, skull, facial bones, sternum, ribs, pelvis, bilateral femurs, bilateral humeri and elbows as well as well as bilateral tibias. There is a focus of increased activity in the right upper abdomen near the midline, which can be due to soft tissue tumor or normal GI activity.Incidental noted are the diffuse opacities in both lungs, predominantly in the paraspinal regions. | Extensive MIBG avid bony metastasis.Focal soft tissue uptake in the right upper abdomen, which can be due to tumor or normal GI activtiy.Diffuse lung opacities in both lungs on CT, which can be due to edema or inflammatory change. |
Generate impression based on findings. | Fall/injury. I see no fracture or malalignment. | No fracture or malalignment. |
Generate impression based on findings. | Evaluate status-post left total knee arthroplasty Components of a left total knee arthroplasty device are situated in near-anatomic alignment without radiographic evidence of complication. Skin staples, a drain, and foci of gas density in the anterior soft tissues reflect recent surgery. | Postoperative changes of total knee arthroplasty. |
Generate impression based on findings. | 50 year-old female with left arm radiculopathy. Please evaluate for cervical spine DJD. Moderate degenerative disk disease affects C4/5, C5/6, and C6/7. There is mild narrowing of the C4/5 and C5/6 neural foramina on the left. Alignment is within normal limits and vertebral body heights are preserved. | Degenerative disk disease as above. |
Generate impression based on findings. | One year follow-up. Spinal stenosis in cervical region. The cervical spine is visualized down to C6/7; the cervicothoracic junction is not well seen due to overlying anatomy. Again seen are postoperative changes of multilevel laminoplasty. There is perhaps mild degenerative disk disease at C3/4 and C4/5. I see no spondylolisthesis or evidence of instability between the flexion and extension views. Note is made of impacted maxillary molars. | Postoperative changes of prior laminoplasty and mild degenerative disk disease as above. |
Generate impression based on findings. | Possible fracture of right second toe. The PIP joint of the second toe is held in flexion, limiting evaluation of the phalanges. I see no fracture line. Please note that I cannot exclude the possibility of a subluxation or dislocation at the PIP joint. The PIP joints of the third and fourth toes are likewise flexed, limiting evaluation of the phalanges. Overall, the bones appear demineralized suggesting osteopenia/osteoporosis. Mild osteoarthritis affects the first metatarsophalangeal joint. There is deformity of the diaphysis of the fifth metatarsal with expansile remodeling that I suspect is due to an old healed fracture. | Limited evaluation of the right second toe shows no fracture line. Please note that I cannot exclude the possibility of a subluxation or dislocation at the PIP joint. If further imaging evaluation is clinically warranted, dedicated toe radiographs may be considered. |
Generate impression based on findings. | 59-year-old female with history of osteoarthritis. Signs and symptoms concerning for ligament tear or meniscal tear. Evaluate for joint disease. Four views of the left knee are provided. Severe osteoarthritis affects the knee, particularly the patellofemoral and lateral compartments. There is perhaps a slight valgus deformity and a small joint effusion. I see no fracture.Four views of the right knee are provided. Severe osteoarthritis affects the knee, particularly the patellofemoral and lateral compartments. There is a valgus deformity and a small joint effusion. I see no fracture. | Severe osteoarthritis as above. Please note that I cannot comment on the integrity of the menisci or ligaments of the basis of conventional radiography. If further imaging evaluation is clinically warranted, MRI may be considered. |
Generate impression based on findings. | Left foot pain. History of trauma. Evaluate for fracture. I see no fracture or malalignment. The is mild soft tissue swelling adjacent to the fifth MTP joint. There is an accessory navicular bone, a normal variant. | No fracture evident. Other findings as above. |
Generate impression based on findings. | Chronic lower back pain. Evaluate for disk disease. The bones are demineralized, suggesting osteopenia/osteoporosis. There is approximately 25% loss of height of L1 indicating a compression fracture of indeterminate age, but not present on the CT scan from 2012. Remaining lumbar vertebral body heights are preserved. Severe degenerative disk disease affects L2/3 and L5/S1. Moderate degenerative disk disease affects L3/4 and L4/5. There is atherosclerotic calcification of the distal abdominal aorta and common iliac arteries. Portions of the spine are obscured by what I presume to be a left ventricular assist device. Note is made of gas-filled and perhaps mildly distended loops of large and small bowel, of uncertain significance, but perhaps representing an ileus. | L1 compression fracture of indeterminate age and degenerative disk disease as above. |
Generate impression based on findings. | Pain. Gait difficulties. I see no fracture. There is mild osteoarthritis of the hip with chondrocalcinosis of the acetabular labrum. Numerous punctate metallic densities in the overlying gluteal musculature likely reflect prior heavy metal injections. Arterial calcifications are also noted within the soft tissues. | Mild degenerative arthritic changes without fracture evident. |
Generate impression based on findings. | History of breast cancer on Aromasin. Fell on ice. Pain in the left knee. Rule-out DJD. Four views of the left knee are provided. The knee appears normal for age, without frank degenerative joint disease. I see no fracture or other findings to account for the patient's pain.The right knee likewise appears normal for age as seen on the frontal view. | Normal-appearing knee without findings to account for the patient's pain. |
Generate impression based on findings. | Clinical question: ICH,? Herniation. Signs and symptoms: ICH. Unenhanced head CT:Examination is limited due to portable technique and motion artifact.Acute hematoma in the left thalamus measuring at 39 x 31 mm which is a slightly smaller than prior exam measurements.Surrounding vasogenic edema without appreciable change. Mass effect and deviation of midline to the right demonstrate no significant change. There is mild decrease in size of the shunted right lateral ventricle since prior study. Similar to prior exam there is near complete effacement of basal cisterns.Complete effacement of cortical sulci in supratentorial space is similar to prior exam. Hemorrhage within the fourth ventricle is again identified with subtle interval decrease. | 1.No evidence of new hemorrhage.2.Slightly smaller left hemispheric hematoma since prior exam as measured.3.Slight decreased size of shunted right lateral ventricle since prior exam.4.Overall mass effect from the hemorrhage and associated mass-effect demonstrate no gross interval change. |
Generate impression based on findings. | Clinical question: Assess for ICP, intimal or any change since prior exam. AMS, ammonia L470 and liver dysfunction. Signs and symptoms: As above. Nonenhanced head CT:There is no detectable intracranial hemorrhage, edema, mass effect, midline shift or hydrocephalus. Tiny focus of low-attenuation in the right occipital lobe identical to prior exam and a non-specific finding.The cerebral cortex as well as cortical sulci and ventricular system remain within normal and stable since prior exam.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells. | No acute intracranial process. No appreciable interval change since prior exam. |
Generate impression based on findings. | Clinical question: Intracranial hemorrhage. Signs and symptoms: SOB, acute change in respiratory status. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Evaluate for acute intracranial process. Signs and symptoms: Left-sided headache. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation for patient's stated age of 29.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells. | Unremarkable nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Head trauma. Signs and symptoms: Head trauma evaluate for hemorrhage. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.There are periventricular and subcortical patchy foci of low attenuation which are nonspecific however often representing age indeterminate small vessel ischemic strokes.Mild prominence of cortical sulci for age is noted. Mild prominence of cerebellar and vermian folia for stated age. Correlate with history and risk factors.Unremarkable calvarium, paranasal sinuses, orbits and mastoid air cells. | 1.No acute intracranial process.2.Age indeterminate small vessel ischemic strokes of moderate degree. |
Generate impression based on findings. | Clinical question: ICH. Signs and symptoms: AMS, syncope, found down and the Snow. Nonenhanced head CT:There is no detectable acute intracranial process CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.There is no detectable post traumatic calvarial or soft tissues of the scalp findings.Large area of encephalomalacia in the right temporal lobe and extending into the right occipital and parietal consistent with a chronic ischemic stroke as was noted on prior exam.Focus of encephalomalacia in the left superior cerebellar consistent with a chronic left superior cerebellar artery ischemic stroke without change since prior exam.Mild ex vacuo dilatation of right lateral ventricle secondary to chronic stroke similar to prior study and with maintained midline. | 1.No acute process.2.Large right MCA and a smaller left superior cerebellar artery territory chronic ischemic strokes without change since prior exam |
Generate impression based on findings. | Right knee washout, spacer in place. Again seen is a cement spacer device. Alignment is near-anatomic. Drains in anterior soft tissue reflect recent surgery. | Cement spacer and surgical drains as above. |
Generate impression based on findings. | Erythema, swelling, tenderness. Infection? There is diffuse soft tissue swelling, particularly along the volar and radial aspects of the wrist and distal forearm. I see no osteolysis to confirm osteomyelitis. Mild degenerative arthritic changes affect the wrist. Deformity of the distal diaphysis of the ulna is incompletely imaged on this study, but I suspect represents an old healed fracture. Deformity of the base of the first metacarpal may also represent prior trauma. | Soft tissue swelling, old posttraumatic changes and osteoarthritis as above. |
Generate impression based on findings. | Clinical question: Rule out bleed or CVA. Signs and symptoms: Altered mental status. Nonenhanced head CT:Examination demonstrate a small focal region of cortical low attenuation of the left posterior frontal with subtle associated mass effect evident by effacement of adjacent cortical sulci (axial images 21 through 23) consistent with previously known subacute nonhemorrhagic ischemic stroke and without change. In addition examination demonstrates subtle patchy foci of low attenuation of white matter although nonspecific likely representing age indeterminate small vessel ischemic stroke of mild degree. This finding also remains grossly identical to prior study.There is asymmetric prominence of right cerebellar folia similar to prior exam and without evidence of abnormal density of parenchyma.Ventricular system remains within normal and maintained midline.Diffuse patchy mucosal thickening of all paranasal sinuses unchanged since prior study. Calvarium and orbits are unremarkable. | 1.No evidence of an acute or new findings since prior exam.2.Revisualization of a stable small left frontal subacute nonhemorrhagic ischemic stroke.3.Findings suggestive of mild age indeterminate small vessel ischemic strokes. |
Generate impression based on findings. | Index finger trauma one week ago, swelling. Evaluate fracture. Maximal pain at DIP. There is diffuse soft tissue swelling. I see no malalignment or fracture. Specifically, the DIP joint is unremarkable. | Soft tissue swelling without fracture or malalignment. |
Generate impression based on findings. | left PCA territorial stroke NONCONTRAST CT HEADThere are evolving acute or subacute ischemic infarction on the left PCA territory involving left fusiform gyrus, parahippocampal gyrus mid-portion and left occipital lobe. These findings do not show any significant interval change since prior exam. There is another subtle low attenuation on the left frontal lobe white matter which again does not show any interval change since prior exam. This lesion may also represent age indeterminate, likely older than subacute ischemic lesion.The ventricles, sulci, and cisterns are symmetric and unremarkable. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. CTA HEAD AND NECKThere is normal aortic arch origin of the right brachiocephalic, left common carotid, and left subclavian arteries. The bilateral vertebral artery origins are normal.There is normal contrast opacification through the bilateral common carotid arteries, carotid bifurcations, cervical internal/external carotid, and vertebral arteries. Bilateral carotid bulb area show wall calcifications but no evidence of arterial luminal stenosis.Left PCA is fetal origin. The left PCA P2-P3 junction is not shown indicating possible severe stenosis of current occlusion. Intracranial carotid system shows extensive wall calcifications and multifocal various degreed arterial luminal stenosis and irregularity indicating atherosclerotic changes. The vertebrobasilar system including right PCA also shows luminal irregularity withe wall calcifications.No evidence of aneurysm or vascular malformation is noted.There is normal superficial and deep intracranial venous drainage. | 1. Evolving subacute ischemic infarction on the left PCA territory, no change since prior exam.2. Subtle low attenuation on the left frontal lobe white matter indicates possible age indeterminate ischemic lesion, no change since prior exam.3. Intracranial atherosclerosis with fetal left PCA with non visualization of the left PCA P2-P3 junction as described above. |
Generate impression based on findings. | Acute worsening in mental status since 2/16 with rigidity, myoclonus, responsive only to pain. Evaluate for any acute abnormality. There is no evidence of intracranial hemorrhage or mass effect. There is parenchymal volume loss. The ventricles and basal cisterns are otherwise unchanged in size and configuration. There is an age-indeterminate lacunar infarct in the left basal ganglia and in the right cerebellar hemisphere. There is no midline shift or herniation. Redemonstrated are an extra-axial calcified lesion adjacent to the right parietal and a separate extra-axial calcified lesion adjacent to the left parietal bone, which most likely represent calcified meningiomas. There are atherosclerotic calcifications of the cavernous internal carotid arteries.There is scattered opacification of the right anterior ethmoid air cells and bilateral sphenoid sinuses. The remaining imaged paranasal sinuses and mastoid air cells are clear. There is chronic deformity of the left lamina papyracea. There is diffuse hazy appearance of the calvarium, which likely represents changes relating to chronic renal osteodystrophy in the setting of known end stage renal disease. The extracranial soft tissues are otherwise unremarkable. There is proptosis and bilateral lens implants. | No evidence of intracranial hemorrhage or mass effect. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct. |
Generate impression based on findings. | 87 years, Female, Reason: eval- hx of EVAR s/p Type 2 endoleak embolization History: eval repair. CHEST:LUNGS AND PLEURA: 1.4-cm (16/22) left upper lobe nodule. There is an additional high-density nodule in the left lower lobe which is slightly increased in size a 1.4 cm (16/56), previously 0.9 cm. Additional scattered micronodules are nonspecific. Resolution of bilateral pleural effusions.MEDIASTINUM AND HILA: Scattered small mediastinal nodes. Atherosclerotic ossification of the aorta and its branches. Mild coronary artery calcifications.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Small splenule.PANCREAS: Mild atrophy of the pancreas.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal sinus cysts are unchanged. Additional renal hypodensities are too small to characterize. RETROPERITONEUM, LYMPH NODES: Aortobiiliac stents without evidence of endo- leak. The aneurysm sac measures 6.2 x 6.6 cm (13/127), previously 5.8 x 6.3 cm. Aneurysmal dilatation of the right common iliac artery measures 2.1 cm (13/145), unchanged. Liquid embolization material within the excluded sac produces extensive streak artifact which precludes evaluation in this region. There are multiple regions of mural calcification and thrombus which are unchanged. SMA and bilateral renal stents are present. IVC filter. BOWEL, MESENTERY: Postsurgical changes of total colectomy with ileoanal anastomosis and right lower quadrant ileostomy with parastomal hernia, unchanged.BONES, SOFT TISSUES: Paraumbilical hernia is unchanged.OTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: Status post hysterectomy. Soft tissue mass in the pelvis adjacent to multiple surgical clips measuring 4.7 x 3.7 cm (15/163).BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Severe degenerative changes of lower lumbar spine.OTHER: Mild pelvic ascites and fat stranding, possibly postsurgical. | 1.No evidence of endoleak status post coiling.2.Pelvic mass which may represent recurrent tumor or collapsed bowel loops. Recommend further evaluation with oral and IV contrast.3.Multiple pulmonary nodules are suspicious for metastatic disease. Follow up CT is recommended.Contrast extravasation description:Supervising radiologist: Dr. TulliusMinor or major extravasation: MinorContrast type: 50 cc of Omnipaque were administered. 25 cc salineAmount extravasated: 75 ccLocation of extravasation: Right ACSigns and symptoms: Swelling without painTreatment given: CompressDischarge instructions given: Yes |
Generate impression based on findings. | Hip pain. Rule out avascular necrosis. Patchy sclerosis in the femoral head is compatible with the suspected diagnosis of avascular necrosis. I see no subchondral fracture or articular surface collapse. Linear sclerosis in the medullary space of the proximal femoral diaphysis may represent additional osteonecrosis. | Findings compatible with osteonecrosis as described above. If further imaging evaluation is clinically warranted, MRI may be considered. |
Generate impression based on findings. | 35-year-old male with history of Crohn's disease with revision of ileocolectomy on 1/24/2015 now with abdominal pain, evaluate for abscess or leak. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Small low attenuation lesion within hepatic segment 6 is not significantly changed compared to the 2012 exam and most likely represents a benign hemangioma.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: Postsurgical changes of prior ileocecectomy with right upper quadrant anastomosis.There is an approximately 5 x 8 cm fat-containing lesion in right abdomen (coronal series, image 51) with adjacent inflammatory changes most consistent with an omental infarct. A small pocket of fluid is present adjacent to the right upper quadrant ileocolonic anastomosis (series 3, image 60) measuring 1.5 x 2.9 cm with adjacent fat stranding. No intraperitoneal free air or additional free fluid.Normal caliber small and large bowel without evidence of obstruction. 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: Postsurgical changes of prior ileocecectomy with right upper quadrant anastomosis.There is an approximately 5 x 8 cm fat-containing lesion in right abdomen (coronal series, image 51) with adjacent inflammatory changes most consistent with an omental infarct. A small pocket of fluid is present adjacent to the right upper quadrant ileocolonic anastomosis (series 3, image 60) measuring 1.5 x 2.9 cm with adjacent fat stranding. No intraperitoneal free air or additional free fluid.Normal caliber small and large bowel without evidence of obstruction. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Postsurgical changes of ileocecectomy.2.Approximately 5 x 8 cm fat-containing lesion in right abdomen with adjacent inflammatory changes most consistent with omental infarct.3.Small pocket of fluid adjacent to the right upper quadrant ileocolonic anastomosis measuring 1.5 x 2.9 cm.4.No bowel obstruction or intraperitoneal free air. Findings discussed by resident on call with Dr. Cannon 7:20 p.m. on 2/17/2015 |
Generate impression based on findings. | 67 years, Male. Reason: Confirm Dobbhoff placement History: Dobbhoff Bihilar lymphadenopathy, better evaluated on recent chest radiograph.Residual enteric contrast within the stomach. Dobbhoff catheter projected over the distal gastric body/antrum. Bowel gas pattern unremarkable. The pelvis is not imaged. | Dobbhoff catheter with tip projected over the distal gastric body. |
Generate impression based on findings. | Bilateral hip pain. Rule out hip fracture. Two views of the right hip are provided. Mild osteoarthritis affects the hip. There is slight prominence of the anterior aspect of the femoral head/neck junction suggesting a cam deformity. I see no fracture.Two views of the left hip are provided. Mild osteoarthritis affects the hip. There is slight prominence of the anterior aspect of the femoral head/neck junction suggesting a cam deformity. I see no fracture.AP view of the pelvis reveals mild osteoarthritis of both hips. Evaluation of the sacrum is limited by overlying bowel contents, but the trabecula of the sacrum appear coarsened suggesting Paget's disease. I see no fracture. | Osteoarthritis of both hips. I see no fracture. |
Generate impression based on findings. | 69-year-old male with leukocytosis and abdominal distention, evaluate for infectious or inflammatory process. Exam somewhat limited by motion.ABDOMEN:LUNG BASES: Please see chest CT done on same day for full details regarding the chest. 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: There is mild ectasia of the infrarenal aorta measuring up to 3.3 X 3.0 cm (series 14, image 92).BOWEL, MESENTERY: Gastrojejunostomy tube with retention device in stomach and distal tip in the proximal jejunum. No significantly dilated bowel to suggest obstruction. Colonic diverticulosis without specific evidence of diverticulitis. No intraperitoneal free air or fluid collections.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Small low attenuation prostatic lesion likely utricle cyst. BLADDER: Foley catheter with proximal tip in collapsed bladder.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Gastrojejunostomy tube with retention device in stomach and distal tip in the proximal jejunum. No significantly dilated bowel to suggest obstruction. Colonic diverticulosis without specific evidence of diverticulitis. No intraperitoneal free air or fluid collections.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No specific evidence of infection in the abdomen or pelvis.2.Colonic diverticulosis without specific evidence of diverticulitis. No bowel obstruction. 3.Mild ectasia of the infrarenal aorta measuring up to 3.3 X 3.0 cm. 4.Please see dedicated chest CT for details regarding the chest. |
Generate impression based on findings. | 58 year-old female status post gastric perforation repair now with tachycardia and pain. ABDOMEN:LUNG BASES: Mild basilar atelectasis. Partially visualized coronary artery calcifications. 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: Mild atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Interval post-surgical changes about the stomach. Much of the previously seen pneumoperitoneum has resolved. There is, however, a new small collection of fluid and gas near the gastrohepatic ligament posterior to the gastric antrum (series 4, image 45) measuring 2.9 x 2.3 cm which may be related to gastric perforation. No bowel obstruction. No additional intraperitoneal free air or fluid collections. Gastric wall thickening compatible with gastritis. BONES, SOFT TISSUES: A small fat containing hernia is present. Mild degenerative changes affect the visualized thoracolumber spine.OTHER: There are numerous foci of gas within the left anterior abdominal wall pannus which are nonspecific but could be related to injections and/or infection.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Interval post-surgical changes about the stomach. Much of the previously seen pneumoperitoneum has resolved. There is, however, a new small collection of fluid and gas near the gastrohepatic ligament posterior to the gastric antrum (series 4, image 45) measuring 2.9 x 2.3 cm which may be related to gastric perforation. No bowel obstruction. No additional intraperitoneal free air or fluid collections. Gastric wall thickening compatible with gastritis. BONES, SOFT TISSUES: Mild degenerative changes affect the visualized thoracolumber spine.OTHER: No significant abnormality noted | 1.Post-surgical changes about the stomach.2.Small collection of fluid and gas near the gastrohepatic ligament adjacent to the gastric antrum measuring 2.9 x 2.3 cm which may be related to gastric perforation. 3.Numerous foci of gas within the left anterior abdominal wall pannus which are nonspecific, correlate for clinical evidence of infection.4.Gastric wall thickening compatible with gastritis. Findings not included in preliminary report discussed with P.A. Tepe at 8:40 a.m. on 2/18/2015. |
Generate impression based on findings. | 59 years, Male. Reason: Dobbhoff History: Dobbhoff Note that the lower portion of the pelvis is excluded from the field-of-view. Dobbhoff tube looped over the stomach with tip projecting over the gastric body. Nasogastric tube tip projects over the distal gastric body. Nonobstructive bowel gas pattern. | Dobbhoff tube looped over the stomach with tip projecting over the gastric body. Nasogastric tube tip projects over the distal gastric body. |
Generate impression based on findings. | 35 years, Female. Reason: 35yoF with known h/o GIB from pancreatitic cancer/XRT, now with acute abdominal pain/distention r/o obstruction/perf History: acute abdominal pain/distention GDA embolization coils in the mid upper abdomen. The tip previously projected over the right lower quadrant on prior study is no longer identified suggesting interval passage of same. Mildly prominent central loops of small bowel, likely reflecting ileus. Evaluation for free intraperitoneal air is limited on this supine view.IUD projected over the pelvis. | Mildly prominent central small bowel loops, likely reflecting ileus. |
Generate impression based on findings. | Knee pain, swelling. Patellar fracture, other fracture? Four views of the right knee are provided. Chronic enthesopathic changes are noted along the anterior aspect of the patella. There is a nondisplaced fracture through an enthesophyte projecting from the anteroinferior aspect of the patella. There is swelling of the overlying soft tissues, but the underlying patellar tendon appears intact. The quadriceps tendon also appears intact. Mild osteoarthritis affects the knee. A small ossicle in the soft tissues along the medial epicondyle of the distal femur may reflect old injury to the medial collateral ligament, but does not have the typical appearance of an acute fracture fragment. Arterial calcifications are noted in the posterior soft tissues. Four views of the left knee are provided. There is soft tissue swelling along the anterior aspect of the patella. There are chronic enthesopathic changes along the anterior aspect of the patella, but I see no fracture. The quadriceps and patellar tendons appear intact. Mild osteoarthritis affects the knee. Arterial calcifications are noted within the posterior soft tissues. | Nondisplaced fracture of right patellar enthesophyte and other findings as described above. |
Generate impression based on findings. | 54-year-old male with history of stem cell transplant patient with diffuse progressive ascending weakness, evaluate for infection. Within the limits of a non IV contrast enhanced examination which limits the ability to evaluate solid parenchymal organs and vascular structures, the following observations can be made: CHEST:LUNGS AND PLEURA: Evaluation of the lung parenchyma is somewhat limited by motion. Scattered nonspecific micronodules. No suspicious nodules or masses. No consolidation or pleural effusions.MEDIASTINUM AND HILA: Right-sided central venous catheter with tip at the SVC atrial junction. No hilar or mediastinal lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydronephrosis or hydroureter. No renal or ureteric calculi.RETROPERITONEUM, LYMPH NODES: Improvement in previously described diffuse infiltrative process in the retroperitoneum/pelvis. BOWEL, MESENTERY: No evidence of bowel obstruction. Post-surgical changes of appendectomy. No intraperitoneal free air or loculated fluid collections.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 evidence of bowel obstruction. Post-surgical changes of appendectomy. No intraperitoneal free air or loculated fluid collections.BONES, SOFT TISSUES: Mild grade 1 anterolisthesis at L5-S1 secondary to pars defect, similar to prior. OTHER: No significant abnormality noted | 1.No specific evidence of infection. 2.Improvement in previously described diffuse infiltrative process in the retroperitoneum/pelvis. |
Generate impression based on findings. | 7-year-old male stepped on glass. Evaluate for foreign body.VIEWS: Left foot AP, oblique, lateral (3 views) 2/17/2015 Faint opacity in the subcutaneous tissues of the heel consistent with a foreign body. No soft tissue swelling or joint effusion is seen. No evidence of fracture or dislocation. | Foreign body in the soft tissues of the heel. |
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