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Generate impression based on findings. | Right proximal tibial lesion. Evaluate for interval change. Again seen is a lucent lesion within the anterior aspect of the proximal tibial diaphysis arising from the cortex with sclerotic margins. It is lobulated and of similar size to that seen on the prior study. | Findings compatible with a nonossifying fibroma of the proximal tibia. |
Generate impression based on findings. | Lumbar pain Moderate degenerative disk disease affects L5/S1. There may also be mild degenerative disease of L3/4 and L4/5. Although oblique views are not provided, there appears to be osteoarthritis of the facet joints. There is a grade 1 anterolisthesis of L4; alignment is otherwise within normal limits. Vertebral body heights are preserved. Bilateral total hip arthroplasties are incompletely imaged on this study. | Degenerative disk disease and other findings as above. |
Generate impression based on findings. | AORTOGRAM: Normal caliber aorta with no evidence of stenosis or aneurysm. The left renal artery is widely patent, the right renal artery is absent.PELVIC ANGIOGRAM: The bilateral common iliac arteries are widely patent. On the right there are several pre-existing metallic stents in the external iliac artery. These are patent. The internal iliac arteries absent. On the left, there is a stent in the external iliac artery with an area of stenosis at its distal portion but does not appear flow limiting. There is a stenosis at the origin of the internal iliac artery.LEFT LOWER EXTREMITY: The visualized portions of the left common femoral artery are widely patent however there is a metallic stent across the common femoral artery crosses the joint space. There is a stent in the proximal superficial femoral artery extending into the proximal anastomosis of a bypass graft. The stent is patent.RIGHT LOWER EXTREMITY: There is a 50% stenosis in the mid common femoral artery which does not appear flow limiting. There is no pressure gradient across the stenosis. The proximal superficial femoral artery is patent, and terminates abruptly after the proximal anastomosis of a bypass graft. The profunda femoris is patent. The native superficial femoral artery and popliteal artery are absent. There is a bypass graft in place with no evidence of twisting or kinking. The bypass graft terminates on the distal popliteal artery with no evidence of anastomotic stricture. The proximal portions of the peroneal and posterior tibial arteries are widely patent. The anterior tibial artery is not well visualized. The mid and distal portions of the peroneal and posterior tibial arteries are widely patent. Comment runoff to the foot is via the posterior tibial artery which continues to supply the plantar arch. The dorsalis pedis artery reconstitutes via peroneal collaterals. Systolic pressures are 104 mm of mercury at the proximal anastomosis of the bypass graft, 113 mm Hg in the external iliac artery, and 125 mm of mercury in the aorta. There is no evidence of a significant pressure drop across the common femoral artery stenosis however there is a pressure differential between the distal external iliac artery and aorta. However, no definitive stenosis is seen in this region.CONTRAST: 62 mL OmnipaqueFLUOROSCOPY TIME: 7.3 minutesAIR KERMA: 192.23 MGyESTIMATED BLOOD LOSS: Less than 5cc. | Patent bilateral iliac stents and patent right superficial femoral artery to tibioperitoneal trunk bypass graft as described above.PLAN: Continue anticoagulation for low graft velocities, continued duplex ultrasound surveillance. |
Generate impression based on findings. | Male, 71 years old, status post right medullary infarct, assess vasculature. Non angiographic findings:Encephalomalacia involving the left occipital lobe and left medial temporal lobe is unchanged. Also stable are numerous small hypoattenuating foci within the left cerebellar hemisphere. Ill-defined periventricular hypoattenuation is again seen, along with a focal lucency within the left basal ganglia, all stable findings.The known right medullary acute infarct is vaguely discernible as an area of hypoattenuation. Otherwise, no new lesions are seen intracranially. There is no evidence of acute intracranial hemorrhage or any new abnormal extra-axial fluid collections. The ventricular system is stable in size morphology including ex vacuo dilatation of the left atrium.Angiographic findings:Conventional aortic branching is seen. Calcified atherosclerotic disease is present at the origin of the right vertebral artery which may consequently be narrowed. There may be mild narrowing of the origin of the left common carotid artery as well. The origins of the remaining great vessels are patent.Calcified atherosclerosis is seen at the origin of the right ICA with no more than 30% stenosis by NASCET criteria. Minimal atherosclerotic disease is seen at the origin of the left ICA with no significant stenosis by NASCET criteria. The carotid vessels are otherwise unremarkable in the neck. Some narrowing at the origin of the right vertebral artery is suspected as above. Aside from this, and a few additional mild foci of calcified atherosclerosis, no significant narrowing of the vertebral arteries is seen in the neck.Moderate severe calcified atherosclerotic disease affects the right intracranial ICA, most severely at the supraclinoid segment where there is at least a 40% stenosis. Mild to moderate atherosclerotic disease affects the left intracranial ICA.Small foci of atherosclerotic calcification are seen along both the V4 vertebral artery segments. In addition, both intracranial vertebral arteries demonstrate some degree of luminal irregularity, more so on the right side. A questionable right PICA is seen with poor contrast opacification overall but particularly at its origin. A left PICA is not clearly seen. The AICAs seem to be present and opacify normally. The SCAs are unremarkable. The basilar artery is of normal caliber. The right PCA opacifies normally with a moderately sized PCOM artery identified. The left PCA fails to opacify just beyond its origin and shows thready opacification distal to that. There may be a very small left PCOM artery.A focal region of moderate narrowing is seen within the A2 segment of the right ACA. No significant stenoses are seen in the larger proximal MCA branches. Scattered mild areas of focal narrowing are suspected in the more distal MCA vessels. No aneurysms are detected. | 1. No clear source vessel is identified to account for the right medullary infarct. Candidate vessels would include the V4 segment of the right vertebral artery which is patent but diffusely irregular likely representing both calcified and noncalcified atherosclerosis. The right PICA also does not opacify robustly, and in particular, its origin is not well seen.2. Significant stenosis affecting the left PCA compatible with chronic infarction in this territory.3. Moderate to severe atherosclerotic disease affects the intracranial ICAs, right side more than left.4. Moderate atherosclerotic disease affects the right ICA origin, with minimal disease of the left ICA origin.5. The origin of the right vertebral artery is likely narrowed by calcified atherosclerosis. |
Generate impression based on findings. | 26-year-old male with right knee injury status post fall on ice last night and soccer injury 3 weeks ago. Decreased range of motion. Pain. Evaluate for fracture. There is a joint effusion, but I see no fracture or malalignment. | Joint effusion without fracture evident. If there is clinical concern for internal derangement, MRI may be considered. |
Generate impression based on findings. | Pain. Evaluate for osteoarthritis. Three views of the right knee are provided. There is mild medial compartment narrowing and small tricompartmental osteophytes indicating mild osteoarthritis. There is also a small joint effusion.Mild osteoarthritis affects left knee as seen on the frontal view. | Mild osteoarthritis. |
Generate impression based on findings. | Acute change in mental status, on heparin gtt. There is no evidence of acute intracranial hemorrhage or mass. There is encephalomalacia in the right interior parietal lobule. The ventricles are unchanged in size and configuration. There is no midline shift or herniation. There are carotid siphon calcifications. There is mild opacification of the ethmoid sinuses. There is minimal fluid within the right mastoid air cells. The skull and scalp soft tissues are unremarkable. There is a partially-imaged enteric tube that traverses the right nasal cavity. | 1. No evidence of acute intracranial hemorrhage.2. Encephalomalacia in the right interior parietal lobule may be attributable to a chronic infarct. |
Generate impression based on findings. | Status post IM rod Again seen is an intramedullary rod and screw device affixing an oblique fracture of the proximal femoral diaphysis in near-anatomic alignment. I see no hardware complication. A mildly displaced lesser trochanter fracture fragment appears similar to that seen on the prior study. Skin staples along the lateral aspect of the thigh are again noted. Mild osteoarthritis affects the hip and knee. There is mild soft tissue swelling. | Orthopedic fixation of proximal femur fracture and other findings as above. |
Generate impression based on findings. | Status post ORIF A plate and screw device affixes a fracture of the distal clavicle in near anatomic alignment. Faint density adjacent to the fracture may represent early callous formation. I see no hardware complications. Acromioclavicular joint alignment is within normal limits. A vascular stent overlies the shoulder. | Orthopedic fixation of distal clavicle fracture as above. |
Generate impression based on findings. | Reason: h/o aspergillus pna History: cough LUNGS AND PLEURA: Stable appearing peripheral interstitial and subpleural fibrosis, most severe in the upper lobes.Apical predominant bronchiectasis and scarring, with upper lobe volume loss, unchanged. Debris within a right upper lobe cavity (series 4, image 25) appears unchanged from the prior exam dated 06/2014.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. Moderate coronary artery calcification. The main pulmonary artery is enlarged, suggestive of pulmonary hypertension.Prominent mediastinal and supraclavicular lymph nodes appear stable to slightly decreased from the prior exam, likely reactive.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Stable findings of chronic changes in the lungs associated with treated aspergillosis. |
Generate impression based on findings. | L1 Chance fracture, back pain. Again seen is anterior wedging of the L1 vertebral body indicating a fracture that appears similar to that seen on the prior study accounting for slight positional differences. Extension of the fracture into the posterior elements is better appreciated on the prior CT scan. There is a negative sagittal balance of approximately 3 cm. I see no scoliosis. | L1 fracture appearing similar to the prior study. |
Generate impression based on findings. | 55 year old female with history of recent liver transplant with erythema around surgical site and ultrasound showing loculated fluid collection. Within the limits of a non IV contrast enhanced examination which limits the ability to evaluate solid parenchymal organs and vascular structures, the following observations can be made: ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Interval postsurgical changes of orthotopic liver transplant.SPLEEN: Splenomegaly similar to prior. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Mildly prominent loops of small bowel without collapse distally and with contrast present in the colon compatible with mild ileus pattern.BONES, SOFT TISSUES: Postsurgical changes to the anterior abdominal wall. There is a collection within the anterior abdominal wall (series 3, image 34; coronal series, image 62) measuring approximately 4.4 x 2.8 x 13 cm corresponding to that seen on recent ultrasound. The collection has a central attenuation approaching simple fluid with a relatively higher attenuation thick rim. The collection does not extend into the peritoneal cavity. No significant surrounding inflammatory stranding. OTHER: No significant abnormality noted | 1.Interval postsurgical changes of orthotopic liver transplant.2.Loculated subcutaneous fluid collection in the anterior abdominal wall. A benign etiology such as a seroma or resolving hematoma is favored, with abscess possible but considered less likely.3.Mild ileus pattern. |
Generate impression based on findings. | Neuroblastoma off therapy. Assess for progression of disease. Normal physiologic radiotracer distribution is seen in the salivary glands, myocardium, liver, and bowel. A focus of activity in the posterior aspect of the intraluminal bladder is most likely layering accumulation of radiotracer.There is no abnormal focus of activity to indicate current MIBG avid tumor. | No convincing MIBG avid tumor is identified. |
Generate impression based on findings. | 64 year old male. History of esophageal cancer. Assess for disease progression. CHEST:LUNGS AND PLEURA: Scattered calcified and noncalcified micronodules, unchanged and most likely post-inflammatory.Serpiginous, irregular vasculature in the right lower lobe (series 4, image 73), unchanged and suspicious for a small vascular malformation.No suspicious pulmonary nodules identified.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Post-surgical findings of esophagectomy and gastric pull up.Normal heart size without pericardial effusion. Mild coronary artery calcification.Right chest wall port tip in the right atrium.CHEST WALL: Lower cervical spine anterior plate and screws, incompletely imaged.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Numerous hypodense hepatic foci, some too small to characterize, unchanged and likely cysts. Some foci have peripheral nodular areas of enhancement and may be hemangiomas. Cholecystectomy clips.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Unchanged thickening of the left adrenal gland.KIDNEYS, URETERS: Mild cortical thinning in the medial aspect of the left kidney, unchanged.PANCREAS: The pancreas is partially fatty replaced.RETROPERITONEUM, LYMPH NODES: Infiltrative retroperitoneal soft tissue at the suture line near the diaphragmatic crus and encasing the celiac axis, unchanged. At the reference level, this measures 2.2 x 3.1 cm, unchanged (series 3, image 98). The abnormal soft tissue extends laterally posterior to the splenic vein and anteriorly is inseparable from the posterior margin of the pancreas.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Mild wall thickening at the distal margin of the pull-up (series 3, image 90) and focal narrowing of the duodenum (series 3, image 93), incompletely assess without oral contrast, but unchanged.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Stable examination with no new sites of disease. |
Generate impression based on findings. | 15-year-old male with concern for SBOVIEW: Abdomen AP (one view) 2/18/15 11:15 Dilated small bowel loops in the midabdomen without air fluid levels may represent partial obstruction or ileus. Stool is noted within the ascending and transverse colon. There is a small amount of distal gas. | Dilated small bowel loops with small amount of distal gas and stool in the colon suggesting partial obstruction or ileus appearing similar to the prior exam. |
Generate impression based on findings. | FeverVIEWS: Chest AP and lateral Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. Peribronchial wall thickening with subsegmental atelectasis left lower lobe. No pleural effusion or pneumothorax. | Bronchiolitis or reactive airway disease. |
Generate impression based on findings. | Pain. There is an oblique fracture of the distal fibula extending to the level of the tibiotalar joint with slight posterior displacement and lateral angulation of the distal fracture fragment. Callus along the fracture indicates an attempt at healing. There is also a vertical fracture through the "posterior malleolus" of the distal tibia displaced posteriorly by 6 mm, with adjacent callus formation indicating an attempt at healing. There may also be a healing fracture of the medial malleolus. A small subcentimeter ossicle overlying the anterior aspect of the tibiotalar joint may represent an additional fracture fragment. There is approximately 5 mm of lateral subluxation of the talus with respect to the long axis of the tibia; the talus is also posteriorly subluxed relative to the long axis of the tibia. There is soft tissue swelling particularly along the anteromedial aspect of the ankle. | Subacute ankle fracture/subluxation as described above. |
Generate impression based on findings. | History of melanoma, now with breast cancer. Assess for bony mets. No abnormal osseous foci are identified to indicate metastatic disease.A focus of uptake in the left mid to distal tibia is likely benign activity and may represent shin splints. Another area of linear activity within the right ischium is also likely benign in etiology. | No evidence of bone metastases. |
Generate impression based on findings. | 10-year-old male with lumbar back pain for weeksVIEWS: Lumbar spine, AP, obliques, and lateral (4 views) 2/18/1511:38, pelvis, AP and frog leg (two views). Pelvis: The femoral heads are well directed within the normally formed acetabula. The osseous structures of the pelvis appear normal for the patient's age.Lumbar spine: Vertebral body heights and disk spaces are maintained. Lumbar alignment is within normal limits. No evidence of spondylolysis or spondylolisthesis. | Normal examination. |
Generate impression based on findings. | Cough feverVIEWS: Chest AP and lateral Cardiothymic silhouette normal. Peribronchial wall thickening with subsegmental atelectasis in the right lower lobe. No pleural effusion or pneumothorax. | Bronchiolitis or reactive airway disease. |
Generate impression based on findings. | Abdominal pain/tightness upper epigastric area, weight loss. Evaluate delayed emptying of her stomach into the duodenum seen on upper GI series. Visually there was progressive, but delayed gastric emptying. Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:30 mins: 81 % of retention 60 mins: 58 % of retention 90 mins: 47 % of retention 120 mins: 34 % of retentionT1/2 gastric emptying was 75 minutes (reference range for half-time of gastric emptying is 10-40 mins) | Delayed gastric emptying. |
Generate impression based on findings. | Pain Two views of the right hip show moderate to severe osteoarthritis of the hip.AP view the pelvis shows the aforementioned osteoarthritis of the right hip. Relatively mild osteoarthritis affects the left hip. Surgical suture material is noted in the right lower quadrant. The remainder of the pelvis is unremarkable. | Osteoarthritis. |
Generate impression based on findings. | Mesothelioma on observation. CHEST:LUNGS AND PLEURA: Fluid in the left pneumonectomy cavity and left diaphragmatic mesh unchanged in appearance. Calcified pleural plaques on the right consistent with previous asbestos exposure. No suspicious pleural thickening or pulmonary nodules on the right.MEDIASTINUM AND HILA: Leftward mediastinal shift. Nonspecific hypoattenuating nodule in the left thyroid gland unchanged in appearance. Small mediastinal lymph nodes unchanged. Unchanged cardiomegaly. Mild coronary artery calcification noted at the origin of the right coronary artery. The left atrium remains compressed between the aorta and vertebral column posteriorly and the right atrium anteriorly.CHEST WALL: No significant abnormality noted..ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Mild intrahepatic biliary ductal dilatation likely related to prior cholecystectomy. Extrahepatic biliary duct is dilated. Hemangioma in left hepatic lobe.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: Pancreas is atrophic; the pancreatic tail is slightly bulbous relative to the proximal tail parenchyma but is unchanged in appearance.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No signs of recurrent or metastatic disease. |
Generate impression based on findings. | Left maxillary alveolar ridge SCCA T4N0, s/p resection with negative margins +perineural invasion 1/31/12, finished XRT 5/8/13. Now with second oral primary on the left lateral tongue pT1N0 SCCA (+) for PNI, and with close margins. Neck: There are postoperative findings related to infrastructure left maxillectomy and left neck dissection and interval left lateral glossectomy. There is irregularity and an area of nonspecific ill-defined enhancement in the left lateral oral tongue that measures 12 x 20 mm. There is mild mucosal thickening within the remaining portions of the left maxillary sinus and oroantral fistula. Otherwise, there is no evidence of mass lesions or significant cervical lymphadenopathy based on size criteria. For example, a left level 1B lymph node measures 7 mm in shift axis, previously also 7 mm. The thyroid and remaining salivary glands are unchanged. There are mild calcifications in the bilateral carotid bifurcations. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear.Head: There is no evidence of intracranial mass. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | 1. Post-treatment findings in the neck with interval left lateral tongue tumor excision, where there is nonspecific ill-defined enhancement in the left tongue, which may represent inflammation and/or tumor. 2. No evidence of intracranial metastases. |
Generate impression based on findings. | Male 64 years old Reason: fx? History: MVC. Small anterior vertebral body osteophytes are noted. The intervertebral disk spaces and vertebral body heights are preserved. There is no acute fracture or subluxation. | No acute fracture or subluxation. |
Generate impression based on findings. | Marginal zone lymphoma with right neck swelling. Needs initial staging.RADIOPHARMACEUTICAL: 7.9 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 89 mg/dL. Today's CT portion of the neck demonstrates an enhancing soft tissue lesion in the region of the right parotid gland measuring approximately 3 cm and an additional enhancing soft tissue nodule with cystic areas in the left parotid gland measuring approximately 2 cm. Multiple borderline jugular lymph nodes are noted bilaterally. Please see diagnostic CT reports for details of the chest, abdomen, and pelvis.Today's PET examination demonstrates a markedly hypermetabolic right parotid mass (max SUV of 17.4) consistent with the patient's diagnosis of lymphoma. A smaller but still markedly hypermetabolic left parotid mass (max SUV of 10.2) is also identified. There are several additional subcentimeter hypermetabolic jugular lymph nodes bilaterally which likely represent additional neck tumor involvement.There is a hypermetabolic focus corresponding to the posterior wall of the inferior trachea (max SUV of 6.5). This is compatible with additional tumor. Given known lymphoma elsewhere this is a consideration, however with atypical features on a recent CT, a primary tracheal neoplasm is also a consideration. Similarly a right bronchus intermedius lesion (max SUV of 6.8) is also compatible with tumor and may represent lymphoma or other primary neoplasm. There is also a small but markedly hypermetabolic focus (max SUV of 9.5) which appears to reside within the distal esophagus. Again this may represent lymphoma, however, the location in the esophagus is somewhat unusual, and an additional neoplasm such as an esophageal tumor should be considered; this can be further evaluated with endoscopy.No suspicious FDG avid lesion is identified in the abdomen, pelvis, or skeleton. | 1.Multiple hypermetabolic foci in the bilateral neck including the parotid glands consistent with lymphoma. 2.Additional hypermetabolic foci compatible with tumor in the inferior trachea, right bronchus intermedius, and distal esophagus may represent additional lymphoma. However, additional synchronous lesions of the airway and esophagus should be considered and may be further evaluated with endoscopy. 3.No suspicious FDG avid tumor below the diaphragm. Diagnostic CTs of the chest, abdomen, and pelvis also performed at today's visit will be reported separately. |
Generate impression based on findings. | Pain. Preop. Two views of the left knee are provided. Severe osteoarthritis affects the knee with near bone-on-bone apposition of the medial tibiofemoral compartment. There are also small tricompartmental osteophytes and a small joint effusion. Components of a right total knee arthroplasty device are situated in near anatomic alignment as seen on the frontal view. The mechanical axis radiograph of the left lower extremity shows approximately 5 degrees of varus alignment of the knee with respect to the neutral mechanical axis. Osteoarthritis affects the right hip. | Osteoarthritis and mild varus deformity as above. |
Generate impression based on findings. | Non-small cell lung cancer, follow-up LUNGS AND PLEURA: Postsurgical changes from left upper lobectomy unchanged. Left basilar scarring with scattered bronchiectasis. Scattered micronodules, many calcified are all unchanged. No suspicious new pulmonary nodules or masses. No effusion.MEDIASTINUM AND HILA: Mediastinal lymphadenopathy remains unchanged. Reference precarinal lymph node remains 1.2 cm (image 40 series 3). The reference cardiophrenic lymph node (image 76 series 3) unchanged measuring 1.5 cm. The prevascular lymph node (image 41 series 3) also unchanged at 1.4 cm.Extensive aortic and more minimal coronary calcifications similar to prior evaluation. Heart and pericardium are otherwise unremarkable.Small hiatal herniaCHEST WALL: Bilateral axillary lymphadenopathy again similar to prior exams. The reference left axillary lymph node persists measuring 1.7 cm (image 25 series 3). Mild degenerative changes of thoracic spine without superimposed new lytic or blastic lesions observedUPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Splenic calcifications compatible with old granulomatous disease exposure. No additional focal abnormalities this limited view of the upper abdomen | Stable appearing lymphadenopathy again likely secondary to known lymphoma. Reference measurements provided |
Generate impression based on findings. | Status post right total hip arthroplasty 6 weeks ago. Evaluate. Two views of the right hip show components of a total hip arthroplasty device situated in near-anatomic alignment without radiographic evidence of hardware complication. The previously seen drain has been removed.The AP view of the pelvis reveals the right total hip arthroplasty. Mild osteoarthritis affects the left hip. The remainder of the pelvis is unremarkable. Degenerative disk disease affects the visualized lower lumbar spine. | Total hip arthroplasty as above. |
Generate impression based on findings. | 18 year-old male, history of desmoplastic tumor post chemo and radiation therapy CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules some of which are calcified appear similar to the prior exam.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Interval resection of large right inferior hepatic metastasis. Hepatic dome lesion has increased in size from the prior exam. Multiple additional hypoattenuating lesions, particularly along the right portal vein appears similar to the prior exam. Multiple surgical clips are again noted within the porta hepatis.SPLEEN: Normal enhancement without focal lesion.PANCREAS: Normal pancreatic enhancement.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Symmetric renal cortical enhancement without evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: Interval removal of necrotic left lower abdominal lymph node.BOWEL, MESENTERY: G-tube tip in the stomach. Surgical material is noted in the left lower quadrant. The bowel is normal caliber.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Moderately distended and otherwise normal.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: The bowel is normal in caliber.BONES, SOFT TISSUES: No osseous lesions.OTHER: No significant abnormality noted | 1. Interval tumor debulking with resection of liver nodules and abdominal lymph nodes. Hepatic dome lesion has increased in size. Multiple additional hepatic metastases are not significantly changed.2. Unchanged pulmonary micronodules. |
Generate impression based on findings. | Hypoxemia evaluate interstitial lung disease. Post inflammatory pulmonary fibrosis. LUNGS AND PLEURA: Low lung volumes, which appear smaller when compared to the earlier exams.Severe pulmonary fibrosis comprised of traction bronchiectasis, subpleural honeycombing, architectural distortion and volume loss. There has been mild progression of disease over the past two examinations.Mild mosaic attenuation of the lung parenchyma on the expiration series with evidence of lobular sparing/air trapping.No suspicious pulmonary nodules or masses. No pleural fluid or pneumothorax.MEDIASTINUM AND HILA: Atherosclerotic calcification of the thoracic aorta and its branches. Mild to moderate coronary artery calcification. Small hiatal hernia. No lymphadenopathy. Upper normal heart size. Physiologic volume of pericardial fluid.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. Atherosclerotic calcifications involving the origins of the mass and any and celiac axis. | Slight progression and severe interstitial lung disease in a pattern most consistent with chronic hypersensitivity pneumonitis. Idiopathic UIP is also within the differential diagnosis. |
Generate impression based on findings. | 5-year-old male with history of neuroblastoma, status post MIBG therapy CHEST:LUNGS AND PLEURA: Note is made of an azygous pseudo-lobe. No nodules or masses.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Right central venous catheter tip extends to the right atrium.CHEST WALL: No axillary or supraclavicular lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: No focal hepatic lesions or biliary ductal dilatation. The gallbladder appears normal.SPLEEN: Normal splenic enhancement.PANCREAS: Normal pancreatic morphology without focal lesion.ADRENAL GLANDS: Interval resection of left adrenal mass. Surgical clips in the left adrenal bed with minimal surrounding soft tissue component are noted. The right adrenal gland appears normal.KIDNEYS, URETERS: Symmetric renal cortical enhancement without hydronephrosis.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: The small bowel is normal in caliber.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: The bladder is markedly distended with fluid.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: The small bowel is normal in caliber.BONES, SOFT TISSUES: No focal osseous lesions. Questionable periosteal reaction along the right proximal femur of unclear significance and bone marrow biopsy tracts in the sacrum.OTHER: No significant abnormality noted | Interval resection of left adrenal mass with mild soft tissue adjacent to the surgical clips which may be postoperative in etiology and can be followed on subsequent imaging. No evidence of metastatic disease. |
Generate impression based on findings. | 94-year-old male patient with chest pain. Per discussion with patient's daughter, chest pain is not associated with swallowing. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions. A bullet projects over the lower thoracic spine.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces or mural contours. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. Fluoroscopic evaluation of esophageal peristalsis demonstrated a cessation of the primary wave at the level of the thoracic inlet with proximal escape and tertiary waves throughout the esophagus distal to the level of the aortic arch.There was mildly delayed passage of a 13 mm barium pill at the gastroesophageal junction.TOTAL FLUOROSCOPY TIME: 6:18 minutes | Moderate to severe esophageal motility abnormality without evidence of esophageal stricture. |
Generate impression based on findings. | Male 58 years old Reason: tophaceous gout History: eval for erosions. Right foot: A soft tissue mass compatible with a gouty tophus is noted. There is gross destruction of the first metatarsal and proximal phalanx with overhanging edges and erosions consistent with tophaceous gout.Left foot: There is a large soft tissue mass in Kager's fat pad consistent with a large gouty tophus. A second large soft tissue mass is seen along the dorsal aspect of the ankle joint and is consistent with a large gouty tophus.Left elbow: No erosions are seen in the left elbow. Right elbow: A dense mass is seen within the olecranon bursa consistent with a gouty tophus. There are no associated bone erosions.Right hand: There is soft tissue swelling along the third finger. A soft tissue mass along the volar aspect of the middle phalanx most represent a gouty tophus. A second soft tissue mass along the dorsal aspect of the wrist most likely represents a gouty tophus.Left hand: No erosions are seen in the left hand.Left shoulder: Minimal degenerative arthritic changes affect the left shoulder. No erosions or gouty tophus is seen. | Findings consistent with tophaceous gout as described above. |
Generate impression based on findings. | Weight loss, small fiber neuropathy. Evaluate left lower lobe pulmonary nodule and mediastinal lymphadenopathy. RADIOPHARMACEUTICAL: 6.9 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 111 mg/dL. Today's CT portion grossly demonstrates borderline enlarged right lower paratracheal and AP window lymph nodes. The previously noted left lower lobe pulmonary micronodule is not demonstrable on this examination. There is mucosal thickening of the right maxillary sinus.Today's PET examination demonstrates a borderline right lower paratracheal lymph node with mild to moderate hypermetabolic activity (max SUV of 3.6). A mildly hypermetabolic left AP window lymph node is also identified (max SUV of 3.2). No additional hypermetabolic lesion is identified.Extensive benign brown fat metabolism is seen within the neck and thorax. | 1. Left lower lobe punctate nodule is not demonstrably FDG avid on this examination, though the small size limits sensitivity.2. Borderline enlarged mediastinal lymph nodes with mild to moderate hypermetabolic activity are considered more likely inflammatory, though, tumor is not entirely excluded. |
Generate impression based on findings. | 46 year old male history of Hodgkin's lymphoma, compared to previous exam. 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: Scattered micronodules are unchanged.MEDIASTINUM AND HILA: Reference pretracheal lymph nodes measures 0.9 x 1.2 cm (series 2, image 41), previously 0.6 x 1.0 cm. Additional small mediastinal stable to slightly increased. CHEST WALL: Reference right axillary lymph node measures 1.8 x 2.5 cm (series 2, image 41), previously 1.0 x 1.9 cm. Additional non-reference axillary lymph nodes have also increased in size. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: Splenomegaly, increased from prior. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Increase in size of iliac lymph nodes (see below). BOWEL, MESENTERY: Large ventral hernia containing multiple loops of small bowel and transverse colon without evidence of complication.BONES, SOFT TISSUES: Large ventral hernia.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: Reference left external iliac lymph node (series 2, image 81) measures 2.2 x 2.3 cm, previously 1.5 x 1.8 cm. There is additional significantly increased bilateral iliac and inguinal chain lymphoadenopathy. For example, left external iliac node (series 2, image 86) measures 3.1 x 6.1 cm. BOWEL, MESENTERY: Large ventral hernia containing multiple loops of small bowel and transverse colon without evidence of complication.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Increased axillary and mediastinal lymphadenopathy, increased splenomegaly, and new extensive pelvic lymphadenopathy suggesting recurrence of lymphoma.2.Large ventral hernia without evidence of complication.3.Cholelithiasis. |
Generate impression based on findings. | 62 years, Male. Reason: Assess stool burden History: Constipation/ abd pain ; on narcotic analgesics Nonobstructive bowel gas pattern. Slightly greater than average stool burden in the colon. Suture material projects over the right hemiabdomen. Surgical staples project over the right upper quadrant and the pelvis. Epidural catheter is partially imaged. IVC filter noted. | Nonobstructive bowel gas pattern with slightly greater than average stool burden. |
Generate impression based on findings. | Lung cancer, please follow-up and reevaluate CHEST:LUNGS AND PLEURA: Diffuse extensive severe centrilobular and paraseptal emphysema. Associated postsurgical embolization coils are observed in the left lower lobe with an associated large left pleural effusion with underlying compression atelectasis. The focal nodular opacity in the left apex (image 11 series 5) remains unchanged at 8 mm. No suspicious new nodules or massesMEDIASTINUM AND HILA: Scattered calcified hilar lymph nodes without suspicious new lymph adenopathyPersistent small to moderate pericardial effusion without additional new cardiac abnormality. Mild annular and coronary calcificationsCongenital variant with a common origin the left common carotid and brachial cephalic trunk.Moderate to large hiatal herniaCHEST WALL: Scattered sclerotic foci throughout multiple vertebral bodies are all unchanged. No suspicious new lytic or blastic lesions, however appearance represent suspected treated metastatic foci. Superimposed extensive degenerative changesABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable small renal cystsPANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: See aboveOTHER: No significant abnormality noted. | Essentially unchanged appearance of large left pleural effusion with underlying compressed lung. No suspicious new findings and stable reference measurements, specifically unchanged suspected osseous treated metastatic foci |
Generate impression based on findings. | 68 years, Male. Reason: ng position History: ng position Enteric feeding tube tip projects over the gastric body. Ileus bowel gas pattern with residual barium in the colon. Subsegmental atelectasis noted in the lung bases.The pelvis is excluded from the field-of-view. | Enteric feeding tube tip projects over the gastric body. |
Generate impression based on findings. | Evaluate pneumoperitoneumVIEW: Chest AP and abdomen AP ET tube tip below thoracic inlet and above the carina. NG tube tip at the GE junction. The umbilical venous catheter tip is probably within the umbilical vein. The umbilical arterial catheter tip at T7. Cardiothymic silhouette normal. Diffuse atelectasis bilaterally without pleural effusion or pneumothorax. Paucity of bowel gas within the abdomen. | Paucity of bowel gas within the abdomen. If there is clinical concern for pneumoperitoneum crosstable lateral is recommended. |
Generate impression based on findings. | Cough, retrocardiac abnormality follow up from chest x-ray (change in appearance of the left atrium between films). LUNGS AND PLEURA: No pneumothorax or pleural fluid. Mild centrilobular and paraseptal emphysema. 2-mm subsolid nodular density at the right apex (4/17) too small to accurately characterize but most likely benign. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Left atrial chamber is mildly prominent, measuring 5.1-cm in AP dimension (3/54). The heart size is otherwise upper normal.No pericardial fluid. No lymphadenopathy. The main pulmonary artery appears normal in caliber. Mild atherosclerotic calcification of the thoracic aorta. No visible coronary calcifications on this non-gated study.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. Atherosclerotic calcification of the abdominal aorta, to visualize due to motion artifact. | 1. Mild emphysema, no other findings to account for the patient's cough. 2. Upper normal heart size with mildly prominent but left atrial chamber. No visible mitral valve calcifications are identified, consider imaging of the mitral valve with echocardiogram or cardiac MRI if required.3. 2-mm micronodule right upper lobe, statistically most likely benign. No other follow-up is required unless the patient is at high risk for primary pulmonary malignancy in which case a 12 month CT follow-up may be obtained. |
Generate impression based on findings. | Images are slightly limited by patient motion. There is diffuse hypoattenuation throughout the brain parenchyma with lack of gray-white differentiation. There is focal abnormal low density along the basal ganglia and thalami. There is near complete effacement of the ventricles with cerebellar tonsillar caudal extension by 8 mm below the level of foramen magnum consistent with herniation. The basal cisterns are effaced. There is diffuse hyperdensity throughout the venous structures likely due to stasis of blood and accentuated by diffuse cerebral edema as all sulci are effaced.There is no midline shift or mass effect. There is no intracranial hemorrhage. There is no extraaxial fluid collection. There is an air-fluid level within the left maxillary sinus. There is diffuse abnormal hyperdensity to the right globe with an unusually dense and prominent lens. Patient is noted to be blind in the right eye on the EMR. There is a thin fat density structure along the outer table of the right lateral frontal bone, likely a small lipoma. | 1. Findings consistent with diffuse cerebral edema secondary to hypoxic ischemic injury, with complete effacement of basal cisterns and sulci as well as near complete effacement of ventricles. Cerebellar tonsillar herniation noted. No acute intracranial hemorrhage.2. Moderate-sized air-fluid level in the left maxillary sinus. Please correlate clinically. |
Generate impression based on findings. | 60 years, Female. Reason: evaluate NG tube placement History: NG tube placement; GI bleeding Enteric feeding tube tip projects over the gastric antrum region. Surgical clips project over the right upper quadrant. Nonobstructive bowel gas pattern. IVC filter, posterior fusion of the lumbosacral spine, and right iliac vascular stent noted. Right-sided pleural effusion and extensive vascular calcifications are noted.The pelvis is excluded from the field-of-view. | Enteric feeding tube tip projects over the gastric antrum region. |
Generate impression based on findings. | 23 year old who experienced severe pain the right breast two weeks ago, presents for ultrasound evaluation. The patient state that she felt pain in the lateral part of right breast. Focused ultrasound did not detect any abnormalities at the area of pain. | No sonographic evidence of malignancy. Clinical follow up is recommended. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Follow up post RT. Lung cancer. CHEST:LUNGS AND PLEURA: Right lower lobe nodule is 11 x 13 mm, previously 10 x 13 mm (series 5, image 181), not significantly changed. Adjacent groundglass and reticular opacities consistent with post-radiation change. Occluded right lower lobe bronchi, unchanged and suspicious for stenosis.Left upper lobe nodule is 7 x 10 mm (series 3, image 63), previously 7 x 9 mm and not significantly changed from 2013, likely benign.Subcentimeter left upper lobe groundglass nodule (series 4, image 34) is unchanged from 2013, may represent focal scar versus a AAH/AIS; special attention on follow-up scans.MEDIASTINUM AND HILA: No hilar lymphadenopathy. Small mediastinal lymph nodes, unchanged.Normal heart size without pericardial effusion.Moderate coronary artery calcification and thoracic aorta atherosclerotic disease.Post surgical findings of total thyroidectomy.CHEST WALL: Left breast calcification, unchanged. No axillary lymphadenopathy.Mild to moderate degenerative changes of the thoracolumbar spine, unchanged. Demineralized bones.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable hypodense foci in the liver, some too small characterize, unchanged and most likely cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Bilateral adrenal thickening with focal left adrenal nodules previously characterized to be adenomas.KIDNEYS, URETERS: Bilateral renal cysts.PANCREAS: Subcentimeter hypodense focus in the pancreatic body, incompletely characterized, unchanged and likely a side branch IPMN.RETROPERITONEUM, LYMPH NODES: Calcified atherosclerotic disease of an ectatic abdominal aorta with mural thrombus as well as severe calcified disease of its branch vessels.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Colonic diverticulosis.BONES, SOFT TISSUES: Mild to moderate degenerative changes of the thoracolumbar spine, unchanged. Demineralized bones.OTHER: No significant abnormality noted. | Stable right lower lobe nodule with post-radiation changes. No new sites of disease. |
Generate impression based on findings. | Male, 56 years old.Missing forceps. Post surgical pneumoperitoneum noted. Nonobstructive bowel gas pattern. Suture material projects left lower quadrant. No unexpected radiopaque foreign object. | No unexpected radiopaque foreign object, specifically no forceps are seen.Findings discussed with Dr. Posner via telephone at 1:29 PM on 2/18/2015 by Dr. McCann. |
Generate impression based on findings. | 1 year old female with breech birth.VIEWS: Pelvis AP and frog leg (two views) 2/18/2015 Normal alignment with no evidence of fracture or dislocation. No soft tissue swelling or joint effusion. Both femoral epiphyses are symmetric bilaterally. | Normal examination. |
Generate impression based on findings. | Soft tissue sarcoma left thigh. Check for disease LUNGS AND PLEURA: Scattered micronodules without evidence of interval change with associated mild scarring in the right lower lobe largely jacent to the midline. No suspicious new nodules or masses. No effusions. Superimposed moderate centrilobular and paraseptal emphysematous changesMEDIASTINUM AND HILA: No lymphadenopathy. Old calcified lymph nodes, compatible granulomatous disease exposureSevere coronary calcifications with mild enlargement of the main pulmonary artery again measuring 3.1 cm, unchanged. The cardiac and pericardium are otherwise within limits.Small hiatal hernia.CHEST WALL: Scattered degenerative changes all unchanged.Nonspecific calcification left breast, unchanged, consider dedicated imagingUPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | No interval change or specific evidence to suggest metastatic disease. Suspected pulmonary hypertension |
Generate impression based on findings. | Postoperative changes of left frontal calvarial craniotomy/plasty including sideplates and screws without significant interval change in positioning. There is no bony trabeculation across craniotomy/plasty sites. Additionally, there is dehiscence of the orbital wall at the superior lateral aspect, unchanged. There is mild sclerosis involving the mildly expanded left sphenoid wing, corresponding to the area of previously demonstrated posttreatment changes. Additionally, the posttreatment changes on MR involving the left masticator space are not well appreciated on the CT examination. Left vidian canal and foramen rotundum again appear somewhat prominent in size.No evidence of intracranial mass, mass effect, or midline shift. No intracranial hemorrhage. Ventricles and sulci are less prominent compared to prior exam, which may be related to therapy. Incidental note is made of a magna cisterna magna. The visualized portions of the paranasal sinuses and mastoid air cells are clear. | 1.Stable left calvarial craniotomy/plasty with no significant interval change in positioning of hardware and lack of osseous trabeculation across the craniotomy sites.2.Mild sclerosis of the mildly expanded left sphenoid wing, most likely related to post treatment changes. |
Generate impression based on findings. | 21 years, Female. Reason: assess for obstipation History: 21 y.o. woman with history of eating disorder and family history of celiac disease. Gas/bloating, abd pain. Average stool burden in the colon. Nonobstructive bowel gas pattern. | Nonobstructive bowel gas pattern with average stool burden in the colon. |
Generate impression based on findings. | 83 years, Male. Reason: continued reflux of tube feedings despite J-tube placement on 2/17, please confirm placement History: continued reflux of tube feedings despite J-tube placement on 2/17, please confirm placement J-tube tip projects over the left hemiabdomen, compatible with jejunal placement past the ligament of Treitz. Nonobstructive bowel gas pattern. Residual enteric contrast is noted in the colon.The lower pelvis is excluded from the field-of-view. | J-tube tip past the ligament of Treitz. |
Generate impression based on findings. | Swelling mass or lump in chest. Evaluate mediastinal mass pre-operatively. History of extragonadal germ cell tumor of mediastinum. CHEST:LUNGS AND PLEURA: Much of the left upper lobe is compressed by the mass. The aerated portion of the lung is unremarkable. No pleural fluid. No suspicious pulmonary nodules.MEDIASTINUM AND HILA: Large heterogeneous mediastinal mass compressing the bronchovascular structures posteriorly. At the level of the right main pulmonary artery, the mass measures 15.3 x 10.3 cm in transaxial dimensions (3/51), previously 15.1 x 9.6 cm. Craniocaudal length of the mass is around 11.7-cm (coronal image 76), about the same. The mass appears to be well encapsulated and contains both cystic and soft tissue components as well as scattered elements of calcification.Heart size is normal. Physiologic volume of pericardial fluid. No coronary calcifications. The main pulmonary artery and right ventricular outflow tract are severely compressed by the massScattered subcentimeter ipsilateral anterior mediastinal and hilar region lymph nodes, some of which appear improved compared to the previous examination such as a left interlobar lymph node seen on series 3 image 54. 7-mm posterior mediastinal (pre-vertebral) lymph node at the level of the T12 vertebral body is unchanged.CHEST WALL: Subcentimeter left internal mammary chain lymph nodes (3/55, 3/60)ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter cortical hypoattenuating lesions too small to accurately characterize.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Subcentimeter retroperitoneal lymph nodes were not included within the scanning range of the most previous examination however are smaller when compared to the outside examination of 10/8/2014 (3/116 for example).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. | Heterogeneous mediastinal mass compatible with provided history of extragonadal germ cell tumor, measurements provided in the body of the report. Small lymph nodes in the chest and upper abdomen are stable to slightly smaller, at least mildly suspicious for nodal metastases given their asymmetry. No evidence of pulmonary or solid organ metastases. |
Generate impression based on findings. | 44 year old woman with history of left breast IDC, additional lesions seen on MR. A targeted left ultrasound was performed for the MR-detected lesion. An ill-defined 9 x 8 x 7 mm hypoechoic area is seen in the left breast at the 6:30 position 4 cm from the nipple, presumably representing the index lesion. An additional, questionable hypoechoic area measuring 5 x 5 x 4 mm is seen closer to the skin surface at the 6:00 position 2 cm from the nipple. No additional abnormal masses are identified. | 1. Hypoechoic area at the 6:30 position likely representing the index lesion.2. Questionable additional hypoechoic area at the 6:00 position, but no definite sonographic correlate for additional lesions seen on MR.If breast conservation surgery is planned, MR guided biopsy is recommend for the MR-detected lesions.BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on findings. | 29 years, Female. Reason: eval for sitz markers History: obstipation Interval removal of rectal tube. The majority of the sitz markers are in the ascending colon and some markers are in the transverse colon. Nonobstructive bowel gas pattern. | The majority of the sitz markers are in the ascending colon and some markers are in the transverse colon. |
Generate impression based on findings. | Reason: Patient participating in research study. Evaluate for lung disease. History: History of rheumatoid arthritis LUNGS AND PLEURA: Mild upper lobe predominant centrilobular emphysema.Scattered benign appearing pulmonary micronodules. No suspicious nodules or masses.Mild basilar atelectasis/scarring. No focal airspace consolidation. No pleural effusions.No evidence of interstitial lung disease or air trapping.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. Severe coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: Mild degenerative disease of the thoracic spine. Severe degenerative joint disease of the bilateral shoulders. UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Mild upper lobe predominant centrilobular emphysema.2. No suspicious nodules or masses.3. No evidence of interstitial lung disease or air trapping.4. Severe degenerative joint disease of the bilateral shoulders. |
Generate impression based on findings. | Reason: mesothelioma History: s/p extended pleurectomy decortication CHEST:LUNGS AND PLEURA: Surgical changes of a recent right pleurectomy and decortication, with moderate right pneumothorax, focal consolidation, and right-sided subcutaneous emphysema. Nodular wall thickening throughout the right hemithorax. For reference, this nodularity was measured, although difficult to fully assess without prior imaging.At the level of the aortic arch (series 3, image 36): The lesion at the 3 o'clock position measures 5 mm. The lesion at the 4 o'clock position measures 9 mm.At the level of the main pulmonary artery (series 3, image 49): The lesion at the 5 o'clock position measures 9 mm. the lesion at the 7 o'clock position measures 10 mm.At the level of the mitral valve (series 3, image 68): Lesion of the 7 o'clock position measures 11 mm. the lesion in the 5 o'clock position measures 6 mm.Extensive left-sided pleural calcification. Scattered pulmonary micronodules on the left. A solid nodule in the left lower lobe measures 7 mm.No focal air space consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. Severe coronary artery calcification.Enlarged mediastinal and hilar lymph nodes, including a right hilar lymph node measuring 17 mm (series 3, image 52) and an AP window lymph node measuring 13 mm (series 3, image 40).CHEST WALL: Status post median sternotomy. Right-sided subcutaneous emphysema from recent surgical procedure. Soft tissue thickening/infiltration in the right chest wall may be post procedural. Degenerative disease of the thoracic spine.Particular note is made of a focal suspicious lytic lesion in the lateral aspect of the right 8th rib (image 48 series 80260 or image 92 series 3) correlating with the prior PET scan lesion.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative disease of the lumbar spine.OTHER: No significant abnormality noted. | Post surgical changes in the right hemithorax of a pleurectomy decortication, with residual nodular pleural thickening and right hilar/mediastinal lymphadenopathy. Reference measurements as above. No definite evidence of disease in the left chest or in the abdomen. Presumably postprocedural changes in the right chest wall, for which close monitoring will be needed on future imaging. |
Generate impression based on findings. | Female 77 years old Reason: lower abdominal pain, eval for diverticulitis History: lower abdominal pain and TTP ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status-post cholecystectomy. 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: Intestinal malrotation with the cecum in the left lower quadrant. Jejunal loops are adherent to the liver. No evidence of obstruction.BONES, SOFT TISSUES: Osteopenia with moderate degenerative changes of thoracic spine.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Mild cervical prolapse.BLADDER: Mild cystocele.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Bowel containing ventral hernia without evidence of obstruction (series 3, image 68). Large rectocele without evidence of diverticulitis. BONES, SOFT TISSUES: Transverse fracture of the S3 vertebrae with callus formation (series 8021, image 73). Bilateral severe sacral insufficiency fractures (series 8020, image 39 and 43). OTHER: Suspicion for pelvic descent with large rectocele and a mild cystocele and mild cervical prolapse. | 1.Transverse fracture of S3 vertebrae with callus formation.2.Bilateral severe sacral insufficiency fractures.3.Global pelvic descent with large rectocele.4.Intestinal malrotation and bowel containing ventral hernia without obstruction.5.No evidence of diverticulitis. |
Generate impression based on findings. | 65 years, Female. Reason: (NEW Replaced) OG placement History: OG placement Mediastinal wires/plates, LVAD, partially visualized pacer leads, Swan-Ganz catheter, and chest tubes are unchanged. Retrocardiac opacity persists. OG tube tip projects over the pyloric area.Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | OG tube tip projects over the gastric pyloric area. |
Generate impression based on findings. | 65 years, Female. Reason: OG placement History: OG placement Mediastinal wires/plates, LVAD, partially visualized pacer leads, Swan-Ganz catheter, and chest tubes are unchanged. Retrocardiac opacity persists. OG is partially visualized although the tip is not clearly seen due to motion. The tip presumably projects over the proximal gastric body. Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | Limited examination due to motion. Within these limitations, the tip is presumed to project over the proximal gastric body. Advancement of the OG tube is recommended. |
Generate impression based on findings. | 9 year old male with decreased range of motion. Evaluate joint space, follow up x-rayEXAMINATION: Left and right hand PA 2/18/2015 12:11 There is diffuse bony demineralization bilaterally, left greater than. Bilateral joint space narrowing between the distal radius and proximal carpal row. Bilateral joint space narrowing between the proximal carpal row and distal carpal row. Bilateral joint space narrowing between the distal carpal row and 2nd metacarpal bone. Probable bony erosion involving the scaphoid bones bilaterally especially at the distal pole. No evidence of fracture or dislocation. | 1. Diffuse bony demineralization bilaterally, left greater than right. 2. Joint space narrowing bilaterally between the distal radius, proximal carpal row, distal carpal row and 2nd metacarpal bone as described above. 3. Bilateral probable bony erosion involving the scaphoid bones especially at the distal pole. |
Generate impression based on findings. | 15 months following left upper lobe resection for non-small cell lung cancer LUNGS AND PLEURA: Postsurgical changes from a left upper lobectomy with volume loss unchanged. The residual small to moderate pleural effusion remains similar in size although now more loculated, specifically along the medial and paravertebral aspect. Scattered moderate emphysematous changes and minimal atelectasis. No suspicious superimposed nodules or masses.MEDIASTINUM AND HILA: Scattered unchanged prevascular lymph nodes, none suspicious for lymphadenopathy.Atherosclerotic changes and severe coronary calcifications without additional cardiac or pericardial abnormality.Moderate hiatal herniaCHEST WALL: Extensive postsurgical changes in the left breast unchanged with surgical clips in the axilla. Sternotomy wires and scattered degenerative changes with scoliosis.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Scattered upper abdominal lymph nodes, again none suspiciously changed or increased in size to suspect lymphadenopathy. | Postsurgical left upper lobectomy with suspected loculated small to moderate left effusion |
Generate impression based on findings. | Reason: Hx breast Ca. History: right chest wall pain. Evaluate for rib fracture for osseous metastasis. Chest X-ray was negative CHEST:LUNGS AND PLEURA: Right anterior subpleural fibrotic changes, likely related to previous radiation therapy.No suspicious pulmonary nodules or masses. No focal air space consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. No visible coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: Healed fractures in the lateral right fourth and sixth ribs, with sclerosis along multiple lateral right ribs in a linear distribution, compatible with posttraumatic origin. No other focal osseous lesions are seen.Status post right breast surgery, right axillary lymph node dissection.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.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. | Healed fractures in the lateral right fourth and sixth ribs, unchanged from the prior exam. No other focal osseous lesions or other acute abnormality. No evidence of metastatic disease. |
Generate impression based on findings. | Supraglottic squamous cell carcinoma LUNGS AND PLEURA: Mild centrilobular emphysema without suspicious superimposed nodules or masses. No effusions. Minimal right basilar scarring and/or atelectasisMEDIASTINUM AND HILA: No lymphadenopathy.The cardiac and pericardium are well within limits.Questionable small hiatal herniaCHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Scattered hepatic cyst without suspicion. No additional abnormalities observed this limited view of the upper abdomen | Minimal right basilar scarring and/or atelectasis without findings to support or suggest metastatic disease |
Generate impression based on findings. | Metastatic ALK + NSCLC, on Crizotinib. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. For example, a right level 5 lymph node measures 7 mm in short axis, previously also 7 mm. The thyroid and major salivary glands are unchanged. The major cervical vessels are patent. The osseous structures are unremarkable. There are bilateral small maxillary sinus retention cysts. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | No evidence of measurable mass lesions or significant lymphadenopathy in the neck to suggest tumor recurrence. |
Generate impression based on findings. | Lung carcinoma ABDOMEN:LUNG BASES: Please refer to separate chest CT report.LIVER, BILIARY TRACT: Status post cholecystectomySPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant change in mildly enlarged retroperitoneal lymph nodes.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 change in mildly enlarged pelvic lymph nodesBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable negative examination. No evidence for acute, inflammatory, or metastatic process. |
Generate impression based on findings. | Grayscale, Color and spectral Doppler were performed on inflow and outflow vessels of the liver.-GRAYSCALE | Patent vasculature with no evidence of biliary dilatation as clinically questioned. |
Generate impression based on findings. | 39 year old with family history of breast cancer in her sister at age 52 presents for annual mammogram. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 65 years, Female. Reason: OG placement History: OG placement Mediastinal wires/plates, LVAD, partially visualized pacer leads, Swan-Ganz catheter, and chest tubes are unchanged. Retrocardiac opacity persists. OG tube tip is obscured by the LVAD. The tip presumably projects over the proximal gastric body. Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | OG tube tip is obscured by LVAD. Tip presumably projects over the proximal gastric body. Advancement is recommended. |
Generate impression based on findings. | Warm, tender, erythematous left ankle There is diffuse swelling about the ankle without underlying fracture, dislocation or osteolysis indicate osteomyelitis. | Diffuse soft tissue swelling without evidence of osteomyelitis. |
Generate impression based on findings. | Thymoma, surgery canceled due pneumonia, evaluate for residual pneumonia. LUNGS AND PLEURA: Interval resolution of air space opacity seen previously in the left lung base. There is some mild residual scarring in and bronchiolitis remaining in the posterior aspect of the left lower lobe.Opacity in the right middle lobe (4/65) has partially cleared, with remaining peribronchial subsolid opacity (4/65). Mild dependent bronchiolitis on the right.MEDIASTINUM AND HILA: The anterior mediastinal mass, adjacent soft tissue nodules and lymph nodes have not significantly changed in appearance.Severe coronary artery calcifications. Large hiatal hernia.CHEST WALL: Severe scoliosis.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Cholelithiasis. Atherosclerotic calcification aorta and its branches. | Resolution of pneumonia with clearance of solid appearing air space components, but residual infectious bronchitis and bronchiolitis in the right middle lobe and left lower lobes. No significant change in mediastinal mass or lymph nodes. |
Generate impression based on findings. | 59 years, Female. Reason: NGT placement History: NGT placement , evaluate position Dobbhoff tube tip projects over the gastric antropyloric region. Cholecystectomy clips and biliary stent is again noted. Surgical sutures project over the right lower quadrant and pelvis. Relatively unchanged bowel gas pattern suggestive of ileus. | Dobbhoff tube tip projects over the gastric antropyloric region. |
Generate impression based on findings. | Reason: evaluate for pulmonary embolism History: acute SOB, cardiac arrest PULMONARY ARTERIES: No evidence of pulmonary embolism. The main pulmonary artery is enlarged, suggestive of pulmonary hypertension.LUNGS AND PLEURA: Small bilateral pleural effusions with segmental and subsegmental basilar atelectasis. No specific evidence of parenchymal pulmonary edema.No suspicious pulmonary nodules or masses are clearly seen.MEDIASTINUM AND HILA: The heart is enlarged. Moderate intermediate density pericardial effusion. Severe coronary artery calcification.No mediastinal or hilar lymphadenopathy.ET tube in place. NG tube terminates in the stomach.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Small perihepatic and perisplenic ascites. Mildly prominent left adrenal gland is partially visualized, without focal nodularity. | 1. No evidence of pulmonary embolism.2. Pleural effusions and basilar atelectasis/consolidation may be related to aspiration or fluid overload.3. Moderate pericardial effusion, nonspecific.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Smoker with weight loss CHEST:LUNGS AND PLEURA: Severe emphysema.No mass lesion.MEDIASTINUM AND HILA: Moderate coronary calcification.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: Stable bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: Mild aneurysmal dilatation of the abdominal aorta again noted with maximal AP diameter of 2.4 cm. Ectasia of bilateral common iliac arteries again noted and unchanged. Stable aortic bypass graft.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Severe emphysema. Moderate coronary calcification. No acute, inflammatory, or neoplastic process appreciated. |
Generate impression based on findings. | 72 -year-old male with history of pancreatic ductal carcinoma and urothelial carcinoma. CHEST:LUNGS AND PLEURA: Scattered nonspecific pulmonary micronodules, some of which are calcified, not significantly changed. No new suspicious nodules or masses.MEDIASTINUM AND HILA: Mild coronary artery calcifications. Stable mild wall thickening of the distal esophagus. CHEST WALL: Degenerative changes affect the visualized thoracolumbar spine. Old right posterior rib fracture. ABDOMEN:LIVER, BILIARY TRACT: Pneumobilia likely related to hepaticojejunostomy.SPLEEN: No significant abnormality notedPANCREAS: Postsurgical changes of Whipple surgery.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Multiple bilateral renal hypodensities are likely cysts with a large exophytic right mid pole lesion which is unchanged. Infiltrative soft tissue lesion extending from the right upper pole pelvis into the cortex described on the previous exam has decreased in size and is less well visualized (series 8, image 119) measuring approximately 1.4 x 2.2 cm, previously 3.1 x 2.3 cm. No hydronephrosis.The kidneys excrete contrast symmetrically. The right ureter is fully opacified, is of normal caliber, and has been reimplanted into the anterior aspect of the bladder. The visualized portions of the left ureter are unremarkable. RETROPERITONEUM, LYMPH NODES: Retroperitoneal lymphadenopathy is overall slightly decreased. Reference pericaval lymph node (series 8, image 109) measures 0.8 x 1.9 cm, previously 1.4 x 2.3 cm.There is ill-defined hypoattenuating soft tissue density in the portacaval space behind the portal vein (series 8, image 103), slightly decreased. BOWEL, MESENTERY: Broad based ventral hernia containing loops of bowel without evidence of obstruction. Reference mesenteric node (series 8, image 109) measures 1.1 x 1.5 cm, previously 1.1 x 1.2 cm. Additional non-reference mesenteric lymph nodes have increased in size. BONES, SOFT TISSUES: Degenerative changes affect the visualized thoracolumbar spine. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Prostatomegaly. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes affect the visualized thoracolumbar spine. OTHER: No significant abnormality noted | 1.Decrease in size of previously described right renal infiltrative lesion suspicious for metastatic transitional cell carcinoma.2.Decreased retroperitoneal lymphadenopathy.3.Increased mesenteric lymphadenopathy.4.Ill-defined soft tissue density behind the portal vein is of uncertain etiology, decreased from prior. 5.Stable distal esophageal wall thickening. |
Generate impression based on findings. | 59 year-old male. Status post salvage esophagectomy. Esophageal cancer. CHEST:LUNGS AND PLEURA: Mild upper lobe paraseptal emphysema. Scattered linear areas of scarring.New small ill-defined nodular and groundglass opacity in the dependent left lower lobe, most likely inflammatory, likely related to aspiration.Calcified left lower lobe nodule consistent with healed granulomatous disease.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Normal heart size without pericardial effusion. Moderate coronary artery calcification. Mitral valve annulus calcification.Post-surgical findings in the neck of prior tracheostomy.Right chest wall port tip terminates in the SVC.CHEST WALL: Collateral vessels in the right chest wall, unchanged. Mild compression deformity of T7 vertebral body, unchanged.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Punctate hepatic hypodensity, unchanged, most likely benign.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Calcified right adrenal, which may be due to prior hemorrhage, unchanged. KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Calcified atherosclerotic disease of the abdominal aorta without aneurysm.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Post-surgical findings of esophagectomy with surgical sutures around the stomach.Percutaneous gastrojejunostomy tube terminates in a jejunal loop.BONES, SOFT TISSUES: Small omental infarct in the mid anterior abdomen, unchanged (series 3, image 131).OTHER: No significant abnormality noted. | New small cluster of nodular and groundglass opacities in the left lower lobe, most likely infectious/inflammatory, possibly related to aspiration. No evidence of pulmonary metastases. |
Generate impression based on findings. | Exam is limited by motion artifact. The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The mastoids are underpneumatized bilaterally. There is suggestion of opacification of the middle ears and diminutive mastoid cavities bilaterally. | No acute intracranial abnormality. Possible fluid opacification of bilateral middle ears and diminutive mastoids for which clinical correlation is recommended. |
Generate impression based on findings. | Concern for osteomyelitis. Within the both the left and right feet, severe degenerative changes are noted with lateral deviation of the distal phalanges. There is severe degenerative change of the first MTP joint bilaterally. Severe degenerative changes are also noted about the tarsal and tarsometatarsal joints bilaterally with areas of fusion. Diffuse osteopenia is noted. No definite fracture or dislocation. Diffuse soft tissue swelling is noted without a definite skin defect. No osteolysis to indicate osteomyelitis. | Severe degenerative changes of the feet bilaterally as described above which has progressed from 2008 but without without evidence of osteomyelitis. |
Generate impression based on findings. | Lung cancer 4 years of Crizotinib. LUNGS AND PLEURA: 4 x 7 mm scar-like density at the site of prior left lower lobe tumor (series 5 image 117) unchanged allowing for differences in scan variability, although this area is difficult to see on the prior study. Scarring extending cranially from this area is unchanged in appearance. No new or suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: 9-mm para-aortic lymph node (previously 10-mm (4/22). Upper normal heart size. No visible coronary artery calcification. No pericardial fluid.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Fatty infiltration of the liver. Cholecystectomy clips. Limited scanning range, please refer to separately reported abdominal CT. | Stable appearance of left lower lobe treatment site, no new or suspicious pulmonary nodules. Stable prominent left para-aortic lymph node. |
Generate impression based on findings. | 40 year-old woman with prior history of palpable mass in the right breast, currently no breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Reason: esophageal cancer FU History: 5 years s/p MIE CHEST:LUNGS AND PLEURA: No suspicious tumor nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: Stable right thyroid hypoattenuating nodule.Status post esophagectomy and gastric pull.No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Minimal coronary calcification.CHEST WALL: Degenerative changes throughout the thoracic spine.ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Numerous hypoattenuating hepatic lesions are unchanged and most likely represent hepatic cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable renal cysts.Nonobstructing right renal calculus.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes of aorta.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Extensive degenerative throughout the lumbar spine. Interval partial collapse of the L4 vertebraeOTHER: No significant abnormality noted. | No evidence of recurrent or metastatic disease. Interval partial collapse of the L4 vertebrae. |
Generate impression based on findings. | Male 76 years old; Reason: scrotal pain History: scrotal pain RIGHT TESTIS: The right testicle measures 3.9 x 1.8 x 4.2 cm. It is diffusely heterogeneous in echogenicity and contains a 1.3 x 0.8 x 1.4 cm multiloculated cyst.LEFT TESTIS: Left testicle measures 2.8 x 3.1 x 2.2 cm. It is heterogeneous in echogenicity and contains a 2.4 x 1.7 x 2.3 cm multiloculated cyst.RIGHT EPIDIDYMIS: The right epididymis measures 2.5 centimeters.LEFT EPIDIDYMIS: Head of the left epididymis measures 0.9 x 0.7 to 0.8 cm. The body of the epididymis is obscured by a 4.2 x 4.3 x 3.1 cm simple cyst.OTHER: Bilateral varicoceles. | 1.Bilateral testicular cysts, benign etiology is favored.2.Left epididymal cyst.3.Bilateral varicoceles. |
Generate impression based on findings. | Hemoglobin dropped after liver biopsy ABDOMEN:LUNG BASES: Small bilateral pleural effusions, right greater than left.LIVER, BILIARY TRACT: Stable hepatic cysts. No evidence for perihepatic fluid collection or hematoma.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant change in left periaortic abnormally enlarged lymph node best seen on image 34 series 3 measuring 1.4 x 2 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable examination without evidence for perihepatic fluid collection or hematoma. No ascites. Stable abnormally enlarged left periaortic lymph node. |
Generate impression based on findings. | HIV poorly compliant to medication and with unknown CD 4 count and bipolar disorder who presented with spiking fevers,and acute onset left neck swelling in the setting of recent 15 lb weight loss. There is extensive cervical lymphadenopathy bilaterally, which has overall increased in size and extent. In particular, there is a left level 2A lymph node that measures up to 27 mm with a substantial component of central hypoattenuation. There extensive edema in the neck soft tissues, particularly in the left parapharyngeal space and supraglottic region, where there is mild airway narrowing. In addition, there is interval increase in size of fluid within the upper retropharyngeal space, measuring up to 7 mm in thickness, previously 4 mm. The superior portion of the left internal jugular vein is less apparent likely due to further compression by the adjacent lymphadenopathy superimposed upon a diminutive variant anatomy. The major cervical arteries are patent. The thyroid and major salivary glands are unremarkable. The osseous structures are unremarkable. The imaged intracranial structures are unremarkable. There is a small left maxillary sinus retention cyst. There is now extensive consolidation of the partially-imaged right lung. | 1. Extensive cervical lymphadenopathy bilaterally likely represents an infectious process, such as a typical or atypical bacterial lymphadenitis, syphilis, among several other potential organisms. In particular, a left level 2A lymph node contains central hypoattenuation, which may represent necrosis or pus. In addition, retropharyngeal fluid, which likely represents an effusion rather than abscess, has increased in size and diffuse edema of the neck soft tissues contribute to airway narrowing particularly in the supraglottic region and apparent compression of the superior left internal jugular vein.2. New extensive consolidation of the partially-imaged right lung, which likely represents a form of pneumonia. Further evaluation via a dedicated chest CT is recommended.Discussed with BARTLETT, ALLISON at 2:45 PM on 2/18/15. |
Generate impression based on findings. | Left hand swelling. Rule-out fracture. Two portable radiographic views of the left hand were obtained and time stamped 1147 and 1149 respectively. There is soft tissue swelling along the dorsum of the hand. We see no underlying fracture. There is a small ossicle along the dorsal aspect of the carpus that appears corticated and may represent old trauma. | Soft tissue swelling without acute fracture. |
Generate impression based on findings. | Neuroblastoma, evaluation prior to transplant. The paranasal sinuses are clear. The nasal cavity is also clear. The nasal septum is essentially midline. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. The nasopharynx, facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable. | No evidence of sinusitis or regional bone metastases. |
Generate impression based on findings. | Reason: RUL nodule; 3 month follow up. PET negative. undergoing work up for liver transplant History: none LUNGS AND PLEURA: Moderate paraseptal emphysema.Dependent atelectasis.A reference right upper lobe solid nodule measures 7 x 6 mm (series 6, image 86), unchanged from the prior exam. Additional scattered benign appearing micronodules and calcified granulomas are unchanged from the prior exam.MEDIASTINUM AND HILA: The heart is mildly enlarged, without pericardial effusion.No mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Status post TACE/RFA of the right hepatic lobe lesion. | Stable 7-mm right upper lobe solid nodule. No new suspicious pulmonary nodules or masses. Continued follow up is recommended to confirm stability.. |
Generate impression based on findings. | Elevated paralyzed right diaphragm, new patient. CHEST:LUNGS AND PLEURA: Mild compressive atelectasis in the right lung. Fine linear scarring anterior right upper lobe. No suspicious nodules or masses. Scattered high-density micronodules are statistically most likely granulomas.MEDIASTINUM AND HILA: There are no masses along the expected course of the right phrenic nerve. 2 to 3-mm high density focus along the anterior tracheal wall at the level of the thoracic inlet (3/3), correlate with direct visualization. The trachea at this level appears slightly narrowed to 8-9 mm cm in transverse dimension (3/3) but is widely patent elsewhere. Very mild coronary artery calcification. Normal heart size. Mild compression of the right atrium due to diaphragmatic elevation. No pericardial fluid.CHEST WALL: Mild degenerative osteophyte or medication the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: The liver appears normal in morphology.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Several tiny (3-5 mm in short axis) lymph nodes are noted in the right paracolic gutter region; the adjacent large bowel and terminal ileum are incompletely assessed given lack of contrast. The adjacent appendix appears normal in caliber.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: The right hemidiaphragm is elevated by approximately 8 cm compared to the left.There are two soft tissue density nodules within the deep fat of the right low back, approximately the level of the right 12th rib tip, measuring 11 and 9-mm (3/130, 3/134).OTHER: No significant abnormality noted. | 1. No masses or structural abnormalities to account for the patient's right diaphragmatic paralysis.2. Small, nonspecific clustered lymph nodes in the right paracolic gutter. These could be post inflammatory if the patient has a history of appendicitis in the past. If further evaluation is required, this area may be evaluated by colonoscopy with attention to the ileocecal region.3. Subcentimeter soft tissue nodules in the deep fat layer of the right low back, of unclear clinical significance, though they are noted to occur near the level of the retroperitoneal lymph nodes.4. Localized narrowing of the cervical trachea at the level of the thoracic inlet with probable small granulomas at this level along the anterior tracheal tracheal cartilage. Correlate for history of prior intubation. The remainder of the trachea and bronchi are normal in appearance. |
Generate impression based on findings. | Reason: eval Type B dissection History: known Type B dissection Evaluation for known aortic dissection is significantly limited given noncontrast examinationLUNGS AND PLEURA: No suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: Stable appearance of dilated distal aortic arch (image 39 series 3) measuring 4.4 cm.No significant change in displacement of intimal calcifications.Hyper-dense crescent demonstrating interval decrease in attenuation compatible with resolving intramural hematoma.Stable hypodense nodule right lobe of thyroid gland.No hilar or mediastinal lymphadenopathy.Cardiac size is normal with evidence of a small pericardial effusion/thickening slightly increased from the prior exam.CHEST WALL: Degenerative changes of the thoracic spine with moderate dextroscoliosis.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Redemonstration of a type B aortic dissection. Examination is limited without the use of intravenous contrast. Intramural aortic hematoma demonstrating decreasing attenuation compatible with resolving hematoma.No significant interval change in the caliber of the thoracic aorta. |
Generate impression based on findings. | Lung cancer and HNC. LUNGS AND PLEURA: Significant motion artifact at the bases limits evaluation.Left lower lobe reference nodule is 3 mm, previously 2 mm (series 4, image 50).New tree-in-bud and nodular opacities in the periphery of the right upper lobe and groundglass opacities in the left base are likely inflammatory/infectious, related to aspiration. Interval resolution of some of previously seen nodular opacities in the right lung.Two more discrete nodules, one in the right upper lobe (series 4, image 34) and in the left base (series 4, image 67) are also likely inflammatory, although special attention on follow-up scans should be paid to confirm resolution.Post-surgical findings of a left lower lobectomy.Moderate centrilobular emphysema.MEDIASTINUM AND HILA: No new mediastinal or hilar lymphadenopathy. Unchanged mildly enlarged left paratracheal lymph node at the level of thoracic inlet. Calcified mediastinal nodes consistent with healed granulomatous disease.Normal heart size without pericardial effusion.No visible coronary calcification. Mild calcification of the thoracic aorta.Postsurgical findings of bilateral neck dissection and supraglottic laryngectomy.Small hiatal hernia. Patulous thoracic esophagus.CHEST WALL: Mild degenerative changes of the thoracic spine. Central lucency in the sternum, unchanged from 2009 and most likely benign.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Scattered hepatic hypodensities, too small to characterize, unchanged. Cholelithiasis. Calcified splenic granuloma.Calcified atherosclerotic disease of the abdominal aorta. | 1. Stable left upper lobe reference nodule.2. New clustered nodular and tree-in-bud opacities in the right lung and groundglass opacities in the left base, likely related to aspiration. Two more discrete nodules are likely also inflammatory/infectious, though special attention should be paid on follow-up exams to confirm resolution. |
Generate impression based on findings. | Female 44 years old Reason: prosthetic assess History: post-op. We have 3 views of the left hip. We have components of a left total hip arthroplasty in near-anatomic alignment without radiographic evidence of complication.We have a single AP view of the pelvis. There are components of a right total hip arthroplasty device situated in near anatomic alignment, although we do not see the distal extent of the prosthesis. There is narrowing/ankylosis of the sacroiliac joints, likely due to seronegative enteropathic spondyloarthropathy. Mild deformity of the lateral aspect of the left iliac wing may be due to old trauma and is unchanged. | Left total hip arthroplasty as above. |
Generate impression based on findings. | Recent colonoscopy demonstrates benign appearing sigmoid stricture; assess for external cause of sigmoid colon and compression ABDOMEN:LUNG BASES: There is a 3.5 mm left lower lobe micronodule (Series 4 Image 6)LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Heterogeneous mildly enlarged spleenPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cystsRETROPERITONEUM, 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: Fibroid uterus. The left lateral aspect of the fibroid uterus abuts against the mid sigmoid colonBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diverticulosis without evidence for acute inflammation or neoplasm. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Fibroid uterus. The left lateral aspect of the uterus abuts against the mid sigmoid colon and many be the explanation for the observed extrinsic impression upon the sigmoid colon seen on colonoscopy. Sigmoid diverticulosis without evidence for acute inflammation or neoplasm. |
Generate impression based on findings. | The ventricles and sulci are slightly prominent for the patient's stated age which may indicate mild global volume loss. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No pathologic extra-axial fluid collection is identified. There is focal prominence of extra-axial space along the posterior inferior cerebellum with mild scalloping of the calvarium, which may relate to a retrocerebellar cyst versus mega cisterna magna.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild scattered mucosal thickening throughout the paranasal sinuses. There are small mucosal retention cysts in the right maxillary sinus. | No acute intracranial abnormality. |
Generate impression based on findings. | Reason: Recurrent head and neck cancer, L oral tongue History: Recurrent head and neck cancer, L oral tongue CHEST:LUNGS AND PLEURA: Stable right lower lobe subpleural nodule measuring 5 mm (image 66 series 5).Scattered calcified and noncalcified micronodules unchanged. No new suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Minor coronary calcification.CHEST WALL: No axillary lymphadenopathy.Degenerative changes in the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes of aorta.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Partial collapse of the L3 vertebra of indeterminate age.OTHER: No significant abnormality noted. | Stable right lower lobe subpleural nodule. No evidence of metastatic disease. |
Generate impression based on findings. | 70 year old female with history of breast cancer and therapy related AML status post stem cell transplant complicated by large B-cell lymphoma now in remission. CHEST:LUNGS AND PLEURA: Small lingular partially calcified pulmonary nodule unchanged since 2009. Additional nonspecific pulmonary micronodules also unchanged. Right apical scarring unchanged.MEDIASTINUM AND HILA: Marked narrowing of the left innominate vein with multiple collateral vessels noted in the thoracic wall. Coronary artery calcifications. No axillary or mediastinal lymphadenopathy. CHEST WALL: Lytic and sclerotic lesions diffusely involving the manubrium, similar to prior. ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis. No focal hepatic lesions. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right renal lower pole low attenuation lesion (series 80232, image 100) was poorly visualized on the prior exam, measures 1.4 x 1.4 cm, does not fulfill requirements for benignity, and is incompletely characterized.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta and its branches. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Symmetric sclerosis of the the bilateral iliac bones adjacent to the SI joints, favor benign process. OTHER: No significant abnormality noted., | 1.1.4-cm lesion in the lower pole of right kidney poorly visualized on the prior exam, does not fulfill requirements for benignity, and is incompletely characterized. Recommend dedicated cross sectional renal imaging. 2.Mixed lytic/sclerotic lesions diffusely involving the manubrium, unchanged.3.High-grade stenosis of the left innominate vein with thoracic wall collateralization, similar to prior. 4.Cholelithiasis. |
Generate impression based on findings. | Sarcoma evaluate for metastatic disease. LUNGS AND PLEURA: Motion artifact degrades image quality, limiting sensitivity for detection of subcentimeter lesions.Calcified micronodule in the lower lobe (4/79) unchanged from an abdominal CT dated 9/14/2010, statistically most likely a granuloma.Dependent atelectasis. No conclusive new or suspicious nodules within the limitations of motion artifact.MEDIASTINUM AND HILA: Atherosclerotic calcification of thoracic aorta and its branches. Moderate coronary artery calcification. Normal heart size. No pericardial fluid or visible lymphadenopathy.CHEST WALL: Stable anterior wedging of midthoracic vertebrae.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Bilateral Bochdalek hernias containing fat. Limited scanning range. Colonic diverticulosis. Nonspecific hypoattenuating lesion in the right hepatic lobe (3/85) was present previously in 9/2010, favoring a benign lesion such as a cyst. | No signs of metastatic disease within the limitations of motion artifact. |
Generate impression based on findings. | 40 year-old female patient with infertility. Scout AP film of the pelvis was normal. Opacification of the uterine cavity revealed a normally oriented uterine cavity without mucosal irregularity or filling defects in the uterine cavity. Both tubes were freely opacified with free spillage on both sides into the pelvis, indicating tubal patency.TOTAL FLUOROSCOPY TIME: 0:42 minutes | Normal uterine cavity and patent fallopian tubes. |
Generate impression based on findings. | Lung carcinoma ABDOMEN:LUNG BASES: Please see separate chest CT report.LIVER, BILIARY TRACT: 0.9 x 0.9 cm low-attenuation focus within the dome of the liver best seen on image 8 on the axial series and image 35 on the coronal series. This lesion was not clearly noted on the prior study.Stable cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Stable left renal cystsRETROPERITONEUM, 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: Uterus absent or atrophicBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | New subcentimeter low-attenuation hepatic dome lesion; a metastatic focus cannot be excluded. Would recommend special attention to this lesion on future surveillance scans. |
Generate impression based on findings. | Female 57 years old Reason: r/o lumbar disc disease History: chronic L-paraspinal muscle pain. There is moderate degenerative disk disease at L4/5 and mild degenerative disk disease at L5/S1. Moderate facet joint osteoarthritis affects the lower lumbar spine. There is a grade 2 anterolisthesis of L4. Vertebral body heights are preserved. | Degenerative disk disease and other findings as above. |
Generate impression based on findings. | Postoperative changes are again noted from previous left frontal temporal craniotomy/cranioplasty. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No pathologic extra-axial fluid collection is identified. There is an incidental probable mega cisterna magna.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.There is no significant residual asymmetric enhancement seen in the partially visualized left masticator space as well as just lateral to the minimally expanded left sphenoid wing. The abnormal enhancement cranially along the lateral orbital wall with associated T2 hyperintensity is less conspicuous. No definite intracranial abnormal enhancement is seen along the area of previous tumor. There is again suggestion of mild asymmetric prominence of the left vidian canal and left foramen rotundum.No abnormal orbital mass or abnormal enhancement is seen. No abnormal signal intensity is evident. The optic nerves are normal in size and signal intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable. | 1. No acute intracranial abnormality.2. Unremarkable contrast-enhanced MR appearance of the orbits, other than for adjacent resolved as well as evolved areas of likely posttreatment change involving the visualized left masticator space and soft tissues along the left lateral orbital wall. Expanded appearance of the left sphenoid wing and pterygoid, an area of previously treated tumor. |
Generate impression based on findings. | Male 19 years old Reason: eval fx 3rd MCP History: same. We have 3 views of the right hand. There is a fracture of the distal diaphysis of the fifth metacarpal with between 20 to 30 degrees of volar angulation of the distal fracture fragment. The third metacarpophalangeal joint appears normal. | Fifth metacarpal fracture as above. |
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