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Generate impression based on findings. | Female 65 years old Reason: Met Ovarian cancer needs evaluation and compare to prior scans. Measurements per RECIST 1:1 bi-dimensional where applicable. History: Met Ovarian cancer needs evaluation and compare to prior scans. Measurements per RECIST 1:1 bi-dimensional where applicable. CHEST:LUNGS AND PLEURA: Nonspecific subcentimeter, peripheral, focal atelectasis on image number 56, series number 3 in the left lower lobe.MEDIASTINUM AND HILA: Interval increase in the size of the mediastinal adenopathy. An index pretracheal node now measures 2.3 by 1.7 cm on image number 22, series number 3. This node was measuring 10 by 15 mm on image number 21, series number two on the previous study.CHEST WALL: Right axillary adenopathy measuring 2 x 1.9 cm in image number 36, series number 3 which is increased in size compared to previous study. This node was measuring 10 x 9 mm on image number 27, series number 2 on the prior study. Other smaller right axillary lymph nodes are also increased in size compared to previous study.ABDOMEN:LIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver, unchanged.SPLEEN: Nonspecific hypodense lesions in the spleen. One of the lesions is slightly increased in size compared to previous study and now measures 1.5 x 1.2 cm on image number 75, series number 3. This lesion was measuring 10 x 7 mm on the previous study on image number 53, series number two.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Retroperitoneal, metastatic adenopathy. Lymph nodes are more prominent in the upper abdomen. An index left para-aortic node now measures 2 x 1.4 cm on image number 93, series number 3. This node was measuring 1.6 x 0.8 cm on image number 63, series number two on the previous study.BOWEL, MESENTERY: Extensive peritoneal carcinomatosis, most prominent in the left upper quadrant which has increased compared to the previous study. Mesenteric metastatic enlarged lymph nodes are also slightly increased in size compared to previous study. An index node measures 2.2 by 1.7 cm on image number 141, series number 3. This node was measuring 1.3 x 1 .3 cm on image number 92, series number two on the previous study. Small amount of ascites.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality noted.LYMPH NODES: Index left external iliac node now measures 1.8 x 1.3 cm on image number 162, series number 3. This node was measuring 1.6 x 1.1 cm on image number 106, series number two on the previous study.BOWEL, MESENTERY: Small amount of ascites. Diffuse peritoneal thickening likely representing peritoneal carcinomatosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Interval increase in the size of the right axillary, mediastinal, retroperitoneal and mesenteric adenopathy and interval increase in the peritoneal carcinomatosis consistent with progression of the disease.Slight interval increase in the size of the splenic lesion. Pelvic adenopathy is stable. |
Generate impression based on findings. | 58 years, Male. Reason: s/p Dobbhoff placement History: same Partially visualized tracheostomy tube. Dobbhoff tube projects over the gastric body. Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view.Pneumomediastinum is noted and better appreciated on chest radiograph. | Dobbhoff tube projects over the gastric body. Pneumomediastinum. Findings discussed with pager 6467 at 0902 on 2/19/15. |
Generate impression based on findings. | 61 years, Female. Reason: c/o post-op abdominal pain History: abdominal pain Cholecystectomy clips project over the right upper quadrant. Degenerative changes affect the pubic symphysis.A 7-mm nodule is noted in the right lung base, seen on prior CTs.Paucity of bowel gas throughout the abdomen. No pneumoperitoneum. | Nonspecific bowel gas pattern, likely post-op ileus. 7-mm right lung base nodule. |
Generate impression based on findings. | 6-year-old male with back pain and vomiting, rule out shunt problemVIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views), abdomen AP/lateral (two views) 2/19/15 3:33 The intracranial portion of the shunt catheter projects to the left of midline, unchanged. Strata valve level is at 1.5. The extracranial shunt tubing extends down the right neck, chest wall and abdomen, with its tip in the right upper quadrant. There is no evidence of kinking or discontinuity of the radiopaque portions of the shunt catheter.No focal pulmonary opacities or pleural effusions. The bowel gas pattern is nonobstructive. MIld bilateral hip dysplasia is again noted. | No kinking or discontinuity of the radiopaque portion of the shunt catheter. |
Generate impression based on findings. | 67 years, Female. Reason: baseline, abdomen soft but pt being empirically treated for C diff and not making stool History: sepsis Cholecystostomy tube projects over the right upper quadrant. Dobbhoff tube catheter projects over the gastric fundus. Nonobstructive bowel gas pattern. Left adrenal calcification as noted on prior CT. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 6-month-old female status post diaphragmatic hernia repairVIEWS: Abdomen, AP and lateral (two views) 2/19/15 Mild diffuse bowel distention without evidence of obstruction. No bowel wall pneumatosis or free intraperitoneal air. | Diffuse small bowel distention without bowel wall pneumatosis or free air, favoring ileus. |
Generate impression based on findings. | 7 year-old female with distal tibial fracture status post reduction.VIEWS: Left tibia/fibula AP and lateral (two views) status post casting, 2/18/2015 at 1649 Evaluation of bony detail is limited by overlying casting material. Again seen is an oblique distal tibial diaphyseal fracture with persistent lateral displacement of the distal fracture fragment. Medial bowing of the fibula and diffuse bony demineralization are again noted. | Distal tibial fracture with persistent displacement of fracture fragments status post reduction as described above. |
Generate impression based on findings. | Female 25 years old Reason: eval for acute process, s/p thumb hyperextension inj 12/25/14, fell yest History: thumb pain. Mild soft tissue swelling. No underlying fracture or malalignment. | No acute fracture or malalignment. |
Generate impression based on findings. | Headaches, history of chronic subdural hematoma, status post evacuation Again seen is a left-sided subdural collection measuring up to 10 mm in thickness along the left frontotemporoparietal convexity similar in size to prior. There is a hematocrit effect. There is increased redistribution along the left greater than right tentorial leaflets. There is mild local mass effect on the left cerebral convexity as well as 3-mm rightward midline shift which is not significantly changed. No downward herniation. No hydrocephalus. Scattered areas of hypoattenuation in the periventricular and subcortical white matter are nonspecific but compatible with chronic small vessel ischemic changes. Left-sided burr holes again seen. Paranasal sinuses and mastoid air cells are clear. | Compared to 2/13/2015, no significant change in size of mixed density left-sided subdural collection. There is slight interval evolution in the attenuation and increase in blood products along the tentorium likely related to redistribution. There is mild mass effect with minimal rightward midline shift which are also unchanged since 2/13/2015. |
Generate impression based on findings. | 2-year-old male with respiratory failure, evaluate ETT position.VIEW: Chest AP (one view) 2/19/15 7:44 The ETT is above the carina. Left central venous catheter tip in the SVC. Enteric tube tip and side port in the stomach. The cardiothymic silhouette is normal.Interval improvement in right upper lobe atelectasis with mild residual streaky opacity. Questionable small left pleural effusion. | Interval improvement in right upper lobe atelectasis with mild residual streaky opacity. |
Generate impression based on findings. | Female 74 years old Reason: evaluate for malignancy, ?primary History: h/o malignant pleural effusion, unknown primary CHEST:LUNGS AND PLEURA: Multiple lung nodules of varying sizes. Ill-defined nodule in the right upper lobe measures 1.2 x 0.9 cm (series 5, image 30). Nodule in the left lower lobe measures 1.3 x 1.1 cm (series 5, image 32). Large bilateral pleural effusions with overlying compressive atelectasis.No definitive evidence of pulmonary embolism. MEDIASTINUM AND HILA: Extensive bilateral hilar and mediastinal lymphadenopathy. Reference right paratracheal node measures 1.8 x 1.4 cm (series 3, image 28). Hypodense, cystic lesion within the left thyroid is likely benign in etiology (series 3, image 5).CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: The liver parenchyma is diffusely heterogeneous and a focal mass cannot be excluded. There is geographic hypodense distribution along the posterior aspect of the right hepatic lobe which is likely secondary to focal fatty deposition. Dedicated MR imaging can be performed to better evaluate.Two subcentimeter hypodense lesions in the left lower lobe which are nonspecific.Diffuse wall thickening of the the gallbladder without evidence of cholelithiasis, likely secondary to generalized anasarca.SPLEEN: No significant abnormality noted. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Hypodense lesion within the left upper pole with a single septation which likely represents a complex renal cyst. Renal mass protocol MR can be performed to further characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Bowel-containing right lumbar hernia without obstruction.BONES, SOFT TISSUES: Nonspecific sclerotic lesion in the T2 vertebral body.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Multiple heterogeneous, enhancing masses in the uterus are not well evaluated but likely represent uterine fibroids. Dedicated imaging can be performed to further evaluate.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Multiple bilateral lung nodules with extensive mediastinal and hilar lymphadenopathy concerning for a primary lung malignancy.2.Large bilateral pleural effusions.3.Bowel-containing right lumbar hernia without evidence of obstruction.4.Hypodense lesion within the upper pole of the left kidney likely represents a complex renal cyst. Renal mass protocol MR can be performed to further characterize if clinically indicated. |
Generate impression based on findings. | 9-year-old male status post ET tube placement.VIEW: Chest AP (one view) 2/19/2015 at 0542 Two right-sided pigtail catheters are again noted, one terminating in the medial aspect of the right hemidiaphragm and the other in the right lower lobe. ET tube tip is between the thoracic inlet and the carina. Feeding tube tip in the stomach. Left central venous catheter tip in SVC. Right PICC tip in right subclavian vein. There is persistent complete opacification of the left hemithorax, likely related to atelectasis and effusion. Right lung aeration is not significantly changed. | Persistent complete opacification of the left hemithorax. |
Generate impression based on findings. | 9-year-old male status post ET tube placement.VIEW: Chest AP (one view) 2/18/2015 at 1732 Two right-sided pigtail catheters are again noted, one terminating in the medial aspect of the right hemidiaphragm and the other in the right lower lobe. ET tube tip is between the thoracic inlet and the carina. Feeding tube tip in the stomach. Left central venous catheter tip in SVC. Right PICC tip in right subclavian vein. There is persistent complete opacification of the left hemithorax, likely related to atelectasis and effusion. Right lung aeration is not significantly changed. | Persistent complete opacification of the left hemithorax. |
Generate impression based on findings. | 40 year-old recalled from screening for a focal asymmetry in the right upper outer breast. An ML view and 3 spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. The areas of focal asymmetry in the right breast disperses on the ML spot views, but partially persists on the CC view. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. ULTRASOUND | 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. | Female 21 years old Reason: Thumb fracture? History: Hand injury. No acute fracture or malalignment. There is, perhaps, trace soft tissue swelling about the thumb. | No acute fracture or malalignment. |
Generate impression based on findings. | 17 year-old female with urinary urgency and intermittent right lower quadrant pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No obstructing renal or collecting system calculi are identified. No perinephric fat stranding or drainable fluid collection. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel obstruction or free air. Above average fecal burden. Appendix not well visualized but there are no secondary signs of appendicitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No ascites.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Normal examination without specific findings to account for the patient's symptoms. |
Generate impression based on findings. | Motion artifact is present. There is a stable right parietal approach ventriculostomy catheter with tip in the left frontal lobe. The lateral ventricles are again collapsed with mild prominence of the quadrigeminal plate, suprasellar color, and suprasellar cisterns. The third and fourth ventricles are also unchanged. There is redemonstration of crowding at the level of the enlarged foramen magnum, now with improved field-of-view and visualization of the cerebellar tonsils extending 2.1 cm below this level. The corpus callosum is not well delineated posteriorly. Platybasia again present with almost a kinked appearance of the cervicomedullary junction.The sulci are within normal limits. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | 1. Stable right parietal approach ventriculostomy catheter with stable ventricular configuration and caliber.2. Persistent mild prominence of the quadrigeminal plate, supracerebellar, and suprasellar cisterns.3. Improved field-of-view allowing for visualization of the caudal extent of cerebellar tonsils beyond the level of the foramen magnum, approximately 2.1-cm, with significant crowding. Findings are consistent with Chiari one malformation, with comparison to prior exams difficult due to previous limited fields of view. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. No suspicious masses, microcalcifications or areas of architectural distortion are present. Benign mass compatible with a normal-sized intramammary lymph node projects in the right upper outer breast. Normal-sized lymph nodes are also seen in each axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually. Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms can be submitted, then an addendum to this report will be made.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Female 31 years old Reason: evaluate for dislocation/fracture History: ankle swelling and pain. There is soft tissue swelling around the lateral malleolus. There is a subtle cortical irregularity along the lateral process of the talus, which may represent an occult facture. | Possible lateral talus fracture with overlying soft tissue swelling. Follow up ankle radiographs in 7-10 days are recommended.Findings verbally relayed to Dr. Saint-Hilaire at 1109 am, on 2/19/2015. |
Generate impression based on findings. | 8-month-old female, intubated, evaluate ETT position. VIEW: Chest AP (one view) 2/19/15 5:16 ETT tip just above the carina. Enteric tube tip extends beyond the field of view. UAC tip at T6/T7. UVC catheter tip at the right SVC/atrial junction. Left PIC catheter tip in the left axilla.Interval improvement in diffuse hazy right pulmonary opacity with persistent underlying bilateral coarse opacities. | Improved right pulmonary opacity. ETT tip just above the carina. |
Generate impression based on findings. | Facial trauma from syncope with left facial TTP and hematoma. No entrapment. There are no fractures identified involving the maxillofacial bones. Bilateral nasal bones, orbits, paranasal sinuses, and zygomatic arches remain intact. Mandible including the temporomandibular joints are intact. Pterygoid plates are intact. Orthodontic hardware is noted involving the right mandibular body. There is soft tissue hematoma in the left malar region. Limited evaluation of the visualized intracranial structures demonstrates mild prominence of the extra-axial CSF spaces likely related to volume loss, but is otherwise unremarkable. | 1. No maxillofacial fractures.2. Soft tissue hematoma in the left malar region. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts with two repeat left MLO views were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. Multiple bilateral benign calcifications are again noted. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Male 53 years old Reason: L hip pain; recent fall History: as above. Mild arthritic changes affect the left hip joint. No evidence of acute fracture | Mild osteoarthritis without evidence of fracture. |
Generate impression based on findings. | IntubationVIEW: Chest AP 2/18/15 ET tube tip immediately above the carina. Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. Minimal patchy atelectasis left upper lobe. No pleural effusion or pneumothorax. Mandibular distraction hardware noted. | ET tube tip immediately above the carina. |
Generate impression based on findings. | 5-year-old female status post suspected displacement of central line.VIEW: Chest AP (one view) 2/18/2015 at 1951 The left central venous catheter has retracted and its tip is now within the left brachiocephalic vein. Normal cardiothymic silhouette. Low lung volumes. Left retrocardiac opacities compatible with left lower lobe atelectasis. | 1.Retracted left central venous catheter with tip in the left brachiocephalic vein. 2.Left lower lobe atelectasis. |
Generate impression based on findings. | 15-year-old male, evaluate PICC placementVIEW: Chest AP (one view) 2/18/15 16:59 Left PICC tip in right atrium. Enteric tube tip in the stomach with side port at the EG junction.The cardiothymic silhouette is normal. No focal pulmonary opacities or pleural effusions. | Left PICC tip in the right atrium. |
Generate impression based on findings. | Male 60 years old Reason: History of left PIP arthroplasties History: History of left PIP arthroplasties. Second through fourth proximal interphalangeal joint prostheses are seen in near-anatomic alignment without radiographic evidence of hardware complication. There is callus formation about a fracture of the base of the fourth middle phalanx, indicating interval healing, without a distinct fracture line. There is marked joint space narrowing and osteophyte formation of the distal interphalangeal joints, compatible with osteoarthritis. No evidence of acute fracture. | Postoperative changes and degenerative changes as described above. Interval healing of fourth middle phalanx fracture. |
Generate impression based on findings. | Positive AFBVIEWS: Chest AP and lateral Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. Minimal atelectasis left lower lobe. No pleural effusion or pneumothorax. | Minimal atelectasis left lower lobe. |
Generate impression based on findings. | 13-year-old female with pain and swelling for one month, rule out bony processVIEWS: Right hand AP, oblique and lateral, left hand AP, oblique and lateral Alignment is anatomic. The osseous structures of each hand appear normal for the patient's age. | No specific findings to account for the patient's symptoms. |
Generate impression based on findings. | 55-year-old with history of right mastectomy for breast cancer on AI. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the left breast. A few scattered benign calcifications are present.Benign appearing lymph nodes are projected over the left axilla and are stable. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 3 year-old male with nasal congestion, assess adenoidsVIEWS: Soft tissue neck, lateral (one view) 2/18/15 17:05 There is prominence of the adenoid tonsils with mild nasopharyngeal airway narrowing. There airway is otherwise patent. The osseous structures appear normal for the patient's age. | Prominent adenoid tonsils with mild nasopharyngeal airway narrowing. |
Generate impression based on findings. | 9-year-old male with fifth metatarsal pain. Evaluate for fracture.VIEWS: Right foot AP oblique lateral (3 views) 2/18/2015 at 2241 Mild soft tissue swelling is noted about the lateral aspect of the foot. However, no underlying fracture or dislocation is present. Alignment is anatomic. No ankle joint effusion. | Mild soft tissue swelling without fracture evident. |
Generate impression based on findings. | Male 53 years old Reason: Fall History: Pain. A small flake of bone is seen along the dorsal aspect of the distal radius on the lateral view, with out evidence of a definite donor site. A well corticated ossicle is seen along the dorsal surface of the right hand on the lateral view and likely represents a carpal boss. | Small flake of bone along dorsal aspect of distal radius without evidence of a definite donor site may represent a fracture. Correlation with point tenderness on physical exam is recommended. |
Generate impression based on findings. | PHARYNX/LARYNX: The right piriform sinus is not well aerated. The nasopharynx, oropharynx, hypopharynx, and larynx are otherwise unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: The postcontrast appearance of the salivary glands is unremarkable. The thyroid gland is unremarkable. ORAL CAVITY: The oral tongue and floor of mouth are unremarkable.CERVICAL SOFT TISSUES: There are no pathologically enlarged cervical lymph nodes.OTHER: The distal one third of the right internal jugular vein is markedly attenuated. There is visualization of a left subclavian to brachiocephalic vein stent, with probable focal narrowing just distal to the stent at its junction with the superior vena cava. This appears similar to that of the prior CT chest. The patient has history of angioplasty of the previously stented left subclavian, brachiocephalic veins as well as the SVC on 1/27/2015. There are numerous prominent anterior chest veins, likely relating to patient's known chronic venous stenoses. There is a retropharyngeal course of the left internal carotid artery.Significant spondylotic changes are again present along the cervical spine with large flowing ventral osteophytes which may relate to diffuse idiopathic skeletal hyperostosis. The mandibular condyles are anteriorly subluxed out of the articular fossae, located caudal to the articular eminence. There is a small air-fluid level in the left maxillary sinus, with mild mucosal thickening in both maxillary sinuses and scattered in the ethmoid air cells. | 1. No abnormality such as focal fluid collection or abscess within the submandibular space. No significant cervical lymphadenopathy. No inflammatory changes identified.2. Left subclavian and brachiocephalic vein stent with suggestion of focal narrowing of the junction with the superior vena cava just distally, with prominent chest collateral veins likely related to known chronic venous stenosis.3. Left maxillary sinus air-fluid level. Please correlate clinically for acute sinusitis. |
Generate impression based on findings. | BiPAP requirementVIEW: Chest AP 2/19/15 Left upper extremity PICC tip in the right ventricle. There is mediastinal shift from left to right. Cardiothymic silhouette normal. Patchy atelectasis in the right lung. No pleural effusion or pneumothorax. | Malpositioned left PICC with patchy atelectasis in the right lung. |
Generate impression based on findings. | 10-year-old male with right foot pain status post twist injury.VIEWS: Right ankle AP oblique lateral (3 views) and right foot AP oblique lateral (3 views), 2/19/2015 at 0236 Foot: No acute fracture or dislocation. Alignment is anatomic. Cortical irregularity about the distal aspect of the first proximal phalanx represents normal variant appearance.Ankle: Mild soft tissue swelling is noted about the ankle. No acute fracture or malalignment. Slight questionable widening of the medial ankle mortise, only seen on the frontal view. | 1.No acute fractures identified. 2.Slight questionable widening of the medial ankle mortise; this can be further evaluated with MRI if there is clinical concern for ligamentous/soft tissue injury. |
Generate impression based on findings. | 67 year old male. OHT December 2014, presenting with hypoxia. Evaluate for underlying lung etiology LUNGS AND PLEURA: Very small bilateral pleural effusions, greater on the right, with adjacent atelectasis.Right lower lobe subpleural wedge-shaped groundglass opacity is suspicious for an infarct, infectious/inflammatory etiologies are less likely.Calcified nodules consistent with healed granulomatous disease.MEDIASTINUM AND HILA: Linear branching hyperdensity in right main and lobar pulmonary arteries is suspicious for pulmonary emboli (series 5, image 44 and 34).Post-surgical findings of heart transplant. Mild cardiomegaly without pericardial effusion. Epicardial pacer wires. No visible coronary artery calcification. Severe calcification of the thoracic aorta.Nonspecific hypodense thyroid nodules.Orphaned radiopaque coil in the left brachiocephalic vein.CHEST WALL: Right upper chest wall surgical clips next to an abandoned vascular stent.Median sternotomy.Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Calcified atherosclerotic disease of the aorta and its branch vessels, including the splenic artery. Cholelithiasis. | 1. Right lower lobe subpleural wedge-shaped groundglass opacity suspicious for a pulmonary infarct. There is a hyperdense filling defect in the right distal main and lobar branches suspicious for pulmonary embolus; confirmation with a CT PE exam or V/Q scan is recommended.2. Very small bilateral pleural effusions.Findings communicated to clinical service over the phone, Dr. Pandya, at time of dictation. |
Generate impression based on findings. | Reason: eval for acute process History: SOB/pleuritic CP, +dimer PULMONARY ARTERIES: No evidence of pulmonary embolism. The main pulmonary artery is normal in caliber.LUNGS AND PLEURA: Stable benign appearing pulmonary micronodules, including a 4 mm nodule along the minor fissure (series 11, image 146) which is likely an intrapulmonary lymph node. No suspicious pulmonary nodules or masses.Minimal basilar scarring/subsegmental atelectasis. 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: Surgical clips in the posterior lower chest wall, from prior soft tissue lesion resection.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of pulmonary embolism or other acute cardiopulmonary abnormality.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | RDS intubatedVIEW: Chest AP 2/19/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. The umbilical arterial catheter again noted. Cardiothymic silhouette normal. Bilateral diffuse atelectasis increased from prior study. No pleural effusion or pneumothorax. | Bilateral atelectasis increased from prior study. |
Generate impression based on findings. | Female 55 years old Reason: Characterize known metastatic breast CA History: History of metastatic breast CA CHEST:LUNGS AND PLEURA: Reference right apical nodule is stable in size and measures 0.9 x 0 .7 cm (series 5, image 20), previously 1.0 x 0.6 cm. Stable small left apical scar-like opacity (series 5, image 27).No new pulmonary nodules identified.No pleural effusions.Postradiation fibrosis and post operative changes at the right lung, stable. Severe biapical emphysematous change.MEDIASTINUM AND HILA: Stable mediastinal lymphadenopathy. Left chest wall port with tip at the cavoatrial junction.CHEST WALL: Right chest wall mass causing destruction of the anterior ribs and sternum with presternal and retrosternal soft tissue extension is stable in size measuring 7.9 x 4.0 cm (series 3, image 63), previously 8.0 x 3.8 cm on CT PE study from 1/19/2015. The chest wall mass has increased in size, however, since prior CT study from 5/28/2014.ABDOMEN: LIVER, BILIARY TRACT: New hypodense lesion within the anterior aspect of the left hepatic lobe measuring 1.0 x 0.8 cm (series 3, image 80).SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Stable destructive right chest wall mass and lung nodules.2.New hypodense lesion within the left lobe of the liver which is suspicious for progression of metastatic disease. |
Generate impression based on findings. | Line placementVIEW: Chest AP and abdomen AP ET tube tip at the level of the thoracic inlet. The umbilical venous catheter tip in the IVC. The prior UVC catheter has been removed in the interval. Cardiothymic silhouette normal. Diffuse atelectasis bilaterally not significantly changed. No pleural effusion or pneumothorax. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum. | The umbilical venous catheter tip in the IVC. |
Generate impression based on findings. | Evaluate right pleural effusion.VIEW: Chest AP (one view) 2/19/2015 at 0522 Loculated right pleural effusion and associated atelectasis have progressed since the prior study. Small left pleural effusion and interval increase in left retrocardiac opacification are also noted. ET tube tip between thoracic inlet and carina. Feeding tube tip in the stomach. Right pleural drain is unchanged. Cardiothymic silhouette at the upper limits of normal. | Interval worsening of right pleural effusion and bibasilar opacities.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Battery, evaluate for fracture There is a soft tissue hematoma in the right malar region, with foci of air likely related to laceration. There are no fractures identified involving the maxillofacial bones. Bilateral nasal bones, orbits, paranasal sinuses, and zygomatic arches remain intact. Mandible including the temporomandibular joints are intact. Pterygoid plates are intact.There is moderate mucosal thickening involving the left sphenoid sinus. Limited evaluation of the visualized intracranial structures is unremarkable. Nonspecific sclerotic focus is seen in the mandible and the right parasymphyseal region, which may represent a bone island. | 1. No maxillofacial fractures.2. Soft tissue laceration and hematoma in the right malar region. |
Generate impression based on findings. | Line placementVIEW: Chest AP and abdomen AP ET tube tip immediately above the level of the carina. There are two umbilical venous catheters with tips at the right internal jugular vein and IVC. Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. Bilateral diffuse atelectasis without pleural effusion or pneumothorax. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum. | Malpositioned ET tube and one of the UVC with tip in the right internal jugular vein. |
Generate impression based on findings. | Tetralogy of Fallot status post repair.VIEW: Chest AP Stable cardiomegaly. Mild patchy right middle and left lower lobe atelectasis but no focal air space opacity or pleural effusion. Right central venous catheter tip in SVC. Right chest tube and epicardial pacing leads are unchanged in position. No evidence of pneumothorax. | Unchanged bilateral patchy atelectasis.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 38-year-old male. Reticular opacities on CXR. Evaluate for infection. LUNGS AND PLEURA: Multiple ill-defined solid nodules with surrounding groundglass opacity bilaterally. The largest nodule measures 12 mm (series 4, image 28). This is consistent with an atypical infection, specifically fungal.Left basilar atelectasis.No pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Normal heart size. Very small pericardial effusion, increased from prior exam.Low-density blood pool consistent with anemia.No visible coronary artery calcification.CHEST WALL: Left PICC tip terminates in the right atrium.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Hypodense 1.7 x 1.8 cm noncystic lesion in the right hepatic lobe (series 3, image 102), unchanged from 2/4/2015 CT abd/pelvis, incompletely characterized.Small amount of perihepatic and perisplenic ascites. Nonspecific moderately enlarged gastrohepatic ligament lymph node (series 3, image 89).Splenomegaly. | 1. Multiple bilateral nodular opacities with surrounding groundglass most consistent with an atypical infection, most likely fungal.2. Small amount of abdominal ascites. 3.Incompletely characterized right hepatic lobe noncystic lesion, unchanged from recent CT abd/pelvis and most likely an incidental benign finding. |
Generate impression based on findings. | Reason: h/o recurrent HNC, s/p cetuximab, eval response, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Scattered benign-appearing micronodules, unchanged. Bilateral tracheobronchial debris, and scattered lower lobe ground glass opacities and nodularity, increased in prominence from the prior exam, compatible with chronic/recurrent aspiration and mucous plugging. Associated partial atelectasis of the right middle lobe is again seen.MEDIASTINUM AND HILA: Surgical changes partially visualized in the upper neck. Tracheostomy tube in place.The heart is normal in size without pericardial effusion. Mild coronary artery calcification. Left arm PICC, tip in the SVC.No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Mild extrahepatic biliary ductal dilatation, unchanged.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scattered nonobstructing small renal calcifications are similar in appearance to the prior exam.PANCREAS: No significant pancreatic ductal dilatation..RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.Gastrostomy tube in place.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No evidence of metastatic disease.2.Bilateral tracheobronchial debris, and scattered ground glass opacities and nodularity, compatible with aspiration and/or mucous plugging. |
Generate impression based on findings. | Recurrent sinusitis. Nasal congestion and discharge. There are postoperative findings related to endoscopic sinus surgery. There is moderate mucosal thickening within the bilateral maxillary sinuses, but the neo-infundibula are largely patent. There is also diffuse opacification of the ethmoid cavities and near-complete opacification of the frontal sinuses bilaterally with suggestion of fluid secretions. Likewise, there is opacification of the sphenoid sinuses with bubbly secretions. There is diffuse thickening of the paranasal sinus walls. There is opacification of the olfactory recesses. The inferior turbinates appear to be lateralized. The nasal septum is deviated towards the left. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. There are multiple dental caries. The nasopharynx, facial soft tissues, and orbits appear to be unremarkable. There is a ventricular shunt in position. | 1. Postoperative findings related to endoscopic sinus surgery with evidence of acute upon chronic sinusitis.2. Dental disease. |
Generate impression based on findings. | For the purposes of numbering, there are 5 lumbar type vertebral bodies. There are postoperative changes related to XLIF from L1 to L5. Interbody spacers are well positioned. There is an obliquely oriented fracture involving the the right lateral aspect of the L2 vertebral body. There is also a split fracture involving the L3 vertebral body with distraction of the fracture fragments. There is central loss of height measuring up to 45%. There is no osseous retropulsion. Levoscoliosis with apex at the L1-L2 level and dextroscoliosis with apex at the L4-L5 level is again seen and can be better assessed on standing images.Multilevel degenerative changes are seen, as describe below:At L1-2 there is mild to moderate right neural foraminal narrowing. No significant spinal canal or left neural foraminal narrowing.At L2-3 there is mild to moderate right neural foraminal narrowing. No significant spinal canal or left neural foraminal narrowing.At L3-4 there is no significant compromise to spinal canal. There is mild right and moderate left neural foraminal narrowing. There is left-sided facet arthropathy.At L4-5 there is mild right and severe left neural foramina stenosis related to disk bulge. Moderate spinal canal stenosis is suspected. There is evidence of prior right-sided laminotomy. Bilateral facet arthropathy.At L5-S1 there is mild right neural foraminal narrowing. No significant compromise to spinal canal or left neural foramen. Bilateral facet arthropathy, advanced on the right..Hematoma seen involving the right psoas musculature and adjacent foci of retroperitoneal air consistent with postsurgical change. IVC filter in place. | 1. Immediate postsurgical changes of XLIF from L1 to L5. Interbody spacers are in adequate position. There is a coronal split fracture involving the L4 vertebral body which extends postero-obliquely on the right. There is central loss of height of approximately 45%. No osseous retropulsion. There is also an obliquely oriented fracture involving the L2 vertebral body involving its right lateral aspect without loss of height or osseous retropulsion. 2. There is moderate left L3-L4 and severe left L4-L5 neural foramina stenosis; additional levels as above. Moderate degree of multilevel spinal canal stenosis is better appreciated on prior MRI. Dr. Ali discussed findings with Lana (Orthopedics NP) at 940 hrs on 2/19/2015. |
Generate impression based on findings. | The ventricles and sulci are prominent, consistent with mild-moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are multiple scattered punctate foci of abnormal T2/FLAIR hyperintensity within the bilateral deep and subcortical white matter with associated diffusion restriction, consistent with acute embolic infarcts. There is also a focus in the left cerebellar hemisphere and left vermis with ADC isointensity and no definite T2 shine through. There is no pathological enhancement. No extra-axial fluid collection is identified. There is a focus of nonspecific susceptibility which may be located in a sulcus along left frontal frontal lobe which may relate to chronic hemosiderin deposition.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is an incidental empty sella. The remainder of the midline structures and craniocervical junction are within normal limits. Incidental note is made of prominent pole likely degenerative or inflammatory soft tissue along the dorsal aspect of the odontoid process which slightly narrows the upper cervical spinal canal. | Multiple scattered punctate likely embolic acute infarcts throughout the cerebral hemispheres, as well as foci in the left cerebellum which may be slightly less acute. |
Generate impression based on findings. | Female 53 years old Reason: R knee pain History: R knee pain. No acute fracture or malalignment. No joint effusion. Tiny osteophytes are seen in the medial tibiofemoral and patellofemoral compartments. | Minimal osteoarthritic changes. |
Generate impression based on findings. | History of breast cancer on chemotherapy with memory loss. There is no evidence of intracranial hemorrhage or mass effect. The ventricles and sulci are diffusely prominent, indicative of mild cerebral volume loss. There are scattered punctate and confluent areas of abnormal low attenuation in the periventricular and subcortical white matter, consistent with age-indeterminate small vessel ischemic changes. There is a chronic-appearing lacunar infarct in the right basal ganglia. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | 1. No evidence of acute intracranial hemorrhage or mass effect. 2. Moderate age-indeterminate small vessel ischemic changes and chronic-appearing right basal ganglia infarct. However, non-contrast CT is insensitive for the detection of non-hemorrhagic acute infarct and metastases.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 38-year-old with history of left breast cancer status post mastectomy Two standard views and two implant displaced views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. Retropectoral silicone implant again noted. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Annual MRI is also recommended given the patient's breast density and young age at cancer diagnosis. This would be due for her in August 2015. The patient also inquired about additional screening with ultrasound. Given that she is getting a superior test (MRI), this may not be necessary. However, if it is clinically desired, a unilateral automated whole breast ultrasound for screening could be performed. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Female 66 years old Reason: hip OA History: hip OA. Severe degenerative arthritic changes affect the bilateral hip joints with near bone on bone apposition of the left and bone on bone apposition of the right. There is severe osteoarthritis of the sacroiliac joints as well as the pubic symphysis. Severe degenerative changes affect the visualized lower lumbar spine. | Severe osteoarthritis of the hips, right greater than left, as described above. |
Generate impression based on findings. | Male 20 years old Reason: third metacarpal fx History: third metacarpal fx. Again seen is a comminuted fracture of the neck of the third metacarpal with minimal volar angulation of the distal fragment. The fracture lines appear less distinct with bony bridging and callus formation to indicate interval healing. | Healing third metacarpal fracture. |
Generate impression based on findings. | 52-year-old with history of bilateral breast reduction and bilateral benign biopsies. The patient states that the previously biopsied area at 12 o'clock feel slightly larger. She has also lost weight over the last year. 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 new dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Bilateral distortion compatible with breast reduction is again noted. Bilateral benign calcifications are present. An area focal asymmetry adjacent to the biopsy clip in the left 12 o'clock position does not appear significantly changed.ULTRASOUND | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 59 years, Female. Reason: Pt pulled dobhoff by "a few centimeters"...need to confirm placement History: pls see above Enteric feeding tube tip projects over the gastric body. Cholecystectomy clips and biliary stent are again noted. Surgical sutures project the right lower quadrant. Stable appearing ileus bowel gas pattern.The lower pelvis is excluded from the field-of-view. | Enteric feeding tube tip projects over the gastric body. |
Generate impression based on findings. | 54 years, Female. Reason: advancement of the NGT History: NGT pushed in by 5 cm Enteric feeding tube is looped in the gastric fundus with tip projecting over the gastric body. Mildly dilated loops of small bowel suggestive of ileus. IVC filter is again noted.The pelvis is excluded from the field-of-view. | Enteric feeding tube is looped in the gastric fundus with tip projecting over the gastric body. |
Generate impression based on findings. | central vertigo No evidence of acute ischemic or hemorrhagic lesion on this scan.Patchy low attenuations on bilateral periventricular white matter indicate non specific small vessel disease.Linear low attenuations on bilateral external capsule indicate age indeterminate but likely chronic ischemic infarction.There is a small focal tissue loss on the left cerebellar hemisphere indicating chronic ischemic infarction.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion.Small vessel ischemic disease as described above. |
Generate impression based on findings. | 33-year-old female patient with history of achalasia status post laparoscopic Heller myotomy and fundoplication in 2009 and recent balloon dilatation 1 week prior. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Single contrast evaluation of the esophagus revealed a moderately dilated thoracic esophagus with some debris and a short segment of intraabdominal esophagus. There was subtle mass effect in the proximal stomach, consistent with fundoplication. The terminal esophagus above the wrap measured 0.6 cm in maximal diameter, not significantly changed compared to prior examination. The contour of the esophagus is smooth with no deformity from the prior myotomy. After several swallows of barium the fluid column was on average 16 cm and at the level of the aortic arch.Fluoroscopic evaluation of esophageal peristalsis demonstrated cessation of the primary wave at the level of the thoracic inlet with proximal escape. There was delayed initiation of the secondary wave. Occasional delayed tertiary waves were seen predominantly in the lower thoracic esophagus.TOTAL FLUOROSCOPY TIME: 3:41 minutes | 1.Persistent achalasia with air-fluid column at the level of the aortic arch.2.Findings compatible with prior fundoplication. |
Generate impression based on findings. | 63 year old male with history of head and neck cancer s/p radiation - evaluate for stricture. Recent OPM study demonstrated tracheal aspiration. Scout radiograph of the chest showed right chest port tip at the superior cavoatrial junction and right apical thickening, pleural effusion. Surgical screws partially visualized in a dysplastic left humerus.Occasional, small volume tracheal aspiration was noted to the level of the mainstem bronchi with absent cough reflex. The aspirate was effectively coughed up. Single contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces or mural contours. No strictures were evident. Prominent compression from aortic arch or possibly left mainstem bronchus is noted. TOTAL FLUOROSCOPY TIME: 3:25 minutes | 1.Tracheal aspiration with absent cough reflex as described above.2.No esophageal strictures were evident. |
Generate impression based on findings. | FractureVIEWS: Left elbow AP, oblique and lateral There are 3 K wires affixing the supracondylar fracture. There is healing of the supracondylar fracture as evidenced by periosteal reaction. The alignment is near anatomic. The overlying cast has been removed in the interval. | Healing supracondylar fracture as described above. |
Generate impression based on findings. | Female 22 years old Reason: eval known radial head fx, any changes in displacement from prev. study History: same. Again seen is a minimally displaced intraarticular radial head fracture with interval decrease in the size of the joint effusion.No significant change in alignment. | Proximal radial head fracture as described above. |
Generate impression based on findings. | ataxic gait, dizziness NONCONTRAST CT HEADNo evidence of acute ischemic or hemorrhagic lesion on this scan.Multifocal scattered low attenuations indicating non specific small vessel disease.If clinically indicated, brain MRI can be considered for further evaluation.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. CTA HEAD Vertebrobasilar system appears to be hypoplastic and shows luminal irregularity indicating atherosclerotic changes. However, basilar artery as well as intracranial bilateral vertebral arteries are patent and do not show significant luminal stenosis. There is normal contrast opacification through bilateral ICAs, MCAs and ACAs. Bilateral PCAs are fetal origin and Acom artery is also patent.There are arterial wall calcifications on bilateral ICAs' cavernous sinus segment indicating atherosclerotic changes.No evidence of aneurysm, significant stenosis, occlusive thrombus, dissection, or vascular malformation is noted.There is normal superficial and deep intracranial venous drainage. | 1. No evidence of acute ischemic or hemorrhagic lesion. Non specific small vessel disease. Brain MRI can be considered for further imaging evaluation if clinically indicated.2. Bilateral fetal PCAs with hypoplastic vertebrobasilar system with atherosclerotic changes. 3. Bilateral distal ICAs also show atherosclerotic changes.4. No significant luminal stenosis, no intracranial arterial aneurysm. |
Generate impression based on findings. | Clinical question: CVA. Signs and symptoms: CVA. Nonenhanced head CT:There is no detectable acute intracranial process. CT however E. is insensitive for early detection of acute nonhemorrhagic ischemic strokes.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation is within normal for patient stated age of 87.No appreciable large vessel intracranial vascular calcification is detected.Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells. | Unremarkable nonenhanced head CT for age. |
Generate impression based on findings. | A paucity of soft tissue is noted in the tonsillectomy beds. There are numerous scattered foci of air within the right and left parapharyngeal space, extending to the skull base on the right. A few of these may be directly indicating with the oropharyngeal mucosa. There is no focal fluid collection or abscess. The largest confluent collection of air on the right measures 2.2 x 0.7 cm, at the level of the mastoid tip and located just anteromedial to the styloid process. There is no evidence of retropharyngeal fluid collection or abscess.PHARYNX/LARYNX: The nasopharynx, oropharynx, hypopharynx, and larynx are otherwise unremarkable. The upper trachea and esophagus are unremarkable. There is no abnormal soft tissue mass or pathological enhancement.GLANDS: The postcontrast appearance of the salivary glands is unremarkable. The thyroid gland is unremarkable. ORAL CAVITY: The oral tongue and floor of mouth are unremarkable.CERVICAL SOFT TISSUES: There are few scattered mildly enlarged cervical lymph nodes, likely reactive. | Scattered foci of air within the right greater than left parapharyngeal space extending to the skull base on the right side, somewhat greater than expected giving timing of surgery two days ago. No focal fluid collection or abscess, especially within the retropharyngeal space. Given the proximity of collections of air and the oropharyngeal airway, correlation direct inspection is recommended to exclude the possibility of direct forming fistulas through the oral mucosa. |
Generate impression based on findings. | There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is mild stable periventricular and subcortical white matter hypoattenuation which is nonspecific, with more focal area in the right frontal subcortical white matter. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There are atherosclerotic calcifications in the right intracranial vertebral artery, and bilateral cavernous carotid arteries. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | No acute intracranial hemorrhage or mass-effect. Mild chronic microvascular ischemic changes. |
Generate impression based on findings. | Pleural mesothelioma. CHEST:LUNGS AND PLEURA: Post-surgical findings of left pleurectomy and decortication with associated volume loss. Diffuse nodular pleural thickening and small amount of loculated fluid at the apex of the left hemithorax consistent with known mesothelioma. Reference measurements as follows:1. At the level the AP window, 7 o'clock position (series 3, image 30): 6 mm, unchanged (series 3, image 30).2. At the level of the pulmonary artery, 12 o'clock position (series 3, image 35): 8 mm, previously 7 mm.3. At the level of the base and right ventricle, 4 o'clock position (series 3, image 81): 14 mm, unchanged. Adjacent nodular pleural thickening at this level is decreased. A pleural nodule in the anterior left upper lobe seen on prior exam (series 4, image 62) has nearly completely resolved.8 mm subpleural nodule left lower lobe has gradually increased in size from 7/2014 (series 4, image 49), suspicious for a metastasis or a primary lung malignancy.No contralateral disease. Scattered unchanged micronodules, likely post-inflammatory. MEDIASTINUM AND HILA: Extensive intrapericardial tumor, not significantly changed except for decreased loculated pockets of fluid. SVC narrowing by tumor, unchanged.Severe coronary artery calcification. Normal heart size.Left hilar lymph node is 9 mm, previously 11 mm (series 3, image 55).CHEST WALL: Small extrathoracic nodule of tumor adjacent to the left 10th rib, unchanged (series 3, image 79). Additional chest wall involvement in the left 8th and 9th intercostal space, unchanged. Mild degenerative changes of the thoracolumbar spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Multiple hepatic cysts, unchanged. No new suspicious hepatic lesions.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: Mild degenerative changes of the thoracolumbar spine.OTHER: No significant abnormality noted. | Stable reference lesions. Enlarging 8 mm subpleural left lower lobe nodule suspicious for suspicious for a metastasis or a primary lung malignancy. A nonreference anterior left pleural nodule and nodular pleural thickening at the base is decreased. |
Generate impression based on findings. | Female 84 years old Reason: eval for progression History: metastatic urothelial cancer CHEST:LUNGS AND PLEURA: Biapical scarring is unchanged. There is new ground glass opacity and cluster of subcentimeter nodules in the right upper lobe. This likely represents atypical pneumonia versus drug reaction. Metastatic disease is much less likely but cannot be entirely excluded.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Patient's known metastatic liver lesion in the right lobe now measures 4.8 by 4.1 cm on image number 85, series number 3, increased in size compared to previous study. Other hypodense lesions in the liver are also increased in size compared to the previous study.SPLEEN: No significant abnormality noted.PANCREAS: Extensive calcifications in the pancreas secondary to chronic pancreatitis. Small peripancreatic nodes are grossly unchanged.ADRENAL GLANDS: Index present left adrenal nodule is unchanged measuring 1.6 by 1.1-cm on image number 91, series number 3.KIDNEYS, URETERS: Soft tissue mass in the left nephrectomy bed now measures 3.6 by 2.7 cm on image number 104, series number 3, smaller compared to previous study. This mass is again invading the aorta and redundant sigmoid colon.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Fat containing periumbilical hernia is.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Limited study due to lack of intravenous contrast. Liver metastases and increase in size compared to previous study. Left nephrectomy bed mass has decreased in size. Adrenal nodule is stable.Interval development of groundglass opacity and cluster of micronodules in the right upper lobe which may represent pneumonia versus drug reaction. Metastatic disease is much less likely but cannot be excluded. |
Generate impression based on findings. | Ms. King is a 67 year old female recalled from screening mammogram for a focal asymmetry in the right breast. She has a personal history of bilateral benign breast biopsies. An ML view and two spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Previously identified focal asymmetry in the central right breast disperses into normal breast parenchyma on spot compression views. Scattered coarse benign calcifications are stable. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually, due next in February 2016. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | T3n1 p16- squamous cell carcinoma of the soft palate, status post chemo RT in 7/2013. There is no evidence of mass lesions in the soft palate or significant cervical lymphadenopathy. However, there is persistent thickening of the cervical esophageal walls. There is an unchanged 10 mm hypoattenuating nodule within the thyroid isthmus and a subcentimeter partially-calcified nodule within the left thyroid lobe. The salivary glands are unchanged. There is mild plaque at the left carotid bifurcation. There is multilevel degenerative spondylosis. The airways are patent. There is unchanged mild medial bowing of the right lamina papyracea. The imaged intracranial structures are unremarkable. There is extensive emphysema within the imaged portions of the lungs. | 1. No evidence of locoregional recurrent tumor or significant cervical lymphadenopathy. 2. Persistent nonspecific thickening of the cervical esophagus may indicate a neoplasm or inflammatory process versus anatomic variation. Further evaluation via endoscopy may be useful.3. Unchanged subcentimeter thyroid nodules. |
Generate impression based on findings. | PET/CT to stage patient with a malignant peripheral nerve sheath tumor.RADIOPHARMACEUTICAL: 11.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 85 mg/dL. Today's CT portion grossly demonstrates numerous cutaneous, subcutaneous, intraabdominal, and intrapelvic, some in the distribution of exiting sacral nerve roots, soft tissue lesions consistent with neurofibromas. There is asymmetric atrophy of multiple muscle groups of the right thigh. There is scoliosis with orthopedic hardware in the thoracic spine. There is right basilar consolidation and apical predominate paraseptal emphysema. There are post-surgical changes in the abdomen including surgical clips and bowel suture material. Today's PET examination demonstrates no significantly hypermetabolic lesion to indicate primary or metastatic malignant nerve sheath tumor. Multiple cutaneous, subcutaneous, and intraabdominal/pelvic smoothly marginated soft tissue lesions, which are consistent with neurofibromas, have low FDG accumulation. A larger typical example of this is seen posterior to the right kidney (max SUV = 1.9). Mild to moderate activity involving both the diaphragms likely represents benign activity. A punctate mild to moderate hypermetabolic focus just anterolateral to the glenohumeral joint likely represents benign inflammation. | No significant FDG avid lesion is identified to indicate malignant nerve sheath tumor. |
Generate impression based on findings. | Male 59 years old Reason: evaluate vasculature to support kidney transplant, hx of gunshot wound resulting in abdominal surgery History: bruit in groin ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left kidney is not visualized.RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcifications throughout the abdominal aorta and bilateral common iliac arteries.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 | Limited study due to lack of intravenous contrast. Moderate atherosclerotic calcifications. Left kidney is not visualized. |
Generate impression based on findings. | Male 37 years old Reason: Pre-kidney/pancreas transplant evaluation. Please assess vasculature to support transplant. History: Pre-kidney pancreas transplant ABDOMEN:LUNG BASES: Bilateral hazy groundglass opacities, nonspecific.LIVER, BILIARY TRACT: Hepatomegaly. Liver measures 29 cm in vertical dimension and extends to the pelvis. The density of the liver is also slightly increased, of unknown etiology and significance.SPLEEN: Nonspecific 1 cm hypodense lesion in a mildly enlarged spleen.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter hypodense lesions in both kidneys. These cannot be optimally evaluated due to lack of intravenous contrast.RETROPERITONEUM, LYMPH NODES: Retroperitoneal borderline enlarged lymph nodes. Index node measures 11 mm in diameter on image number 62, series number 3 in the left para-aortic space. Etiology and significance of these lymph nodes is unknown. No significant atherosclerotic calcifications involving the abdominal aorta and its major branches.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: Pelvic adenopathy. Index right external iliac node measures 2 x 1.3 cm on image number 99, series number 3. Index right inguinal lymph node measures 3 x 1.7 cm on image number 123, series number 3.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Penile prosthesis and its reservoir is noted. Small vessel wall calcifications compatible with patient's known diabetes. | Limited study due to lack of intravenous contrast. Retroperitoneal and pelvic adenopathy of uncertain etiology and significance. Lymphoma cannot be excluded. Inguinal adenopathy is amenable for biopsy.Hepato- splenomegaly and high density liver. Etiology is unknown. |
Generate impression based on findings. | 57 year old woman with history of prior benign biopsy 20 years ago. Currently complains of itchiness of the skin over the right breast for the last 6 months. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Specifically, there is no abnormality or skin thickening seen in the right breast at the site of patient's reported symptoms. Benign appearing lymph nodes are projected over both axillae. | No finding to account for the patient's symptoms and 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. | Shortness of breath. Post inflammatory pulmonary fibrosis. Evaluate ILD. LUNGS AND PLEURA: Diffuse subpleural honeycombing, traction bronchiectasis, and architectural distortion greater in the bases consistent with a UIP pattern, not significantly changed.8mm solid nodule in the superior segment of the right lower lobe is unchanged from 6/2014 CT (series 8, image 31), likely benign. In retrospect, the nodule was also solid on that prior study, but appeared nonsolid due to dense vascular enhancement and the apparent change in density was spurious.MEDIASTINUM AND HILA: Nonspecific mildly enlarged mediastinal lymph nodes, unchanged, which is likely related to the interstitial lung disease.Normal heart size without pericardial effusion.No visible coronary artery calcification.CHEST WALL: Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | On further review of earlier scans, the 8 mm solid nodule in the right lower lobe is unchanged from 6/2014, and likely benign. However, continued follow-up is recommended and the case was discussed with Dr. Strek at the time of reporting. |
Generate impression based on findings. | Female 62 years old Reason: eval for recurrence History: h/o RCC in 2008 CHEST:LUNGS AND PLEURA: Subcentimeter lung nodules in both lungs. The index nodule in the right upper lobe is unchanged measuring 4-mm in diameter image number 24, series number 5.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged. Index cardiophrenic node is unchanged measuring 1.3 by 1 cm on image number 67, series number 3.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: 1.5-cm hypodense lesion in the liver on image number 74, series number 3 is minimally increased compared to previous study.. MRI may be helpful for further characterization of this lesion if clinically indicated. Hepato- megaly is unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Status post right nephrectomy. Left kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Nonspecific solitary hypodense lesion in the liver on known etiology and significance. MRI is recommended for further evaluation. Metastatic disease cannot be excluded. This lesion is minimally increased compared to previous study from 2014 and significantly increased compared to the study from 2012. |
Generate impression based on findings. | 74 years, Female, Reason: incidental finding at outside hospital of renal artery mass at outside hospital with non-diagnostic biopsy History: weight loss, current smoking, cervical LAD. CHEST:LUNGS AND PLEURA: Moderate centrilobular emphysema. Left basilar atelectasis. No focal consolidation or pleural effusion. Right lower lobe granuloma. No suspicious nodule.MEDIASTINUM AND HILA: For findings in the neck, please see dedicated neck CT exam. Enlarged left supraclavicular lymph nodes including a node measuring 1.6 x 1.1 cm (5/12) which is hypermetabolic on PET. This appears slightly less prominent than the prior PET/CT, however, direct comparison cannot be made as measurements not able to be made on prior fused PET/CT images. Atherosclerotic calcifications of the aorta and its branches. Prominent precarinal node, not hypermetabolic on prior PET. Moderate coronary calcifications. Enlarged left prevertebral and paraesophageal nodes including a node measuring 1.1 x 1.7 cm (5/81) which were hypermetabolic on PET and are grossly stable.CHEST WALL: Hypodensity with sclerotic borders within the distal right clavicle at the acromioclavicular joint is most likely benign/degenerative.ABDOMEN:LIVER, BILIARY TRACT: Left hepatic lobulated hypodensity may represent a small complex cyst or hemangioma.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Bulky retroperitoneal lymphadenopathy is overall decreased. A lesion encasing the left renal artery measures 3.1 x 2.9 cm (5/101), previously 3.9 x 2.8 cm. Additional enlarged retroperitoneal nodes are decreased in size. Portacaval lymphadenopathy is also decreased.BOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.PELVIS: FemaleUTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Severe arthritic changes at the right hip. Moderate degenerative changes of the spine. Hypodensity with sclerotic borders within the distal right clavicle at the acromioclavicular joint is most likely benign/degenerative. | 1.Lesion adjacent to the left renal artery likely represents retroperitoneal lymphadenopathy and is decreased in size from the prior study.2.Although not measurable on prior PET/CT, supraclavicular lymphadenopathy is subjectively decreased and mediastinal lymphadenopathy is grossly stable. |
Generate impression based on findings. | Recurrent base of tongue squamous cell carcinoma now on palliative chemotherapy. Neck: There are post-treatment findings related to total glossectomy with graft reconstruction, neck dissection, and tracheostomy. There is diffuse stranding and swelling of the fat planes of the neck and face. There is a persistent defect in the left floor of mouth region with bubbly secretions in the cavity and ill-defined soft tissue along the margins. There is also slight demineralization along the overlying lingula aspect of the mandible body. There is also a persistent substantial defect in the left parapharyngeal region and medial masticator space that appears to communicate with the oropharynx with surrounding ill-defined soft tissue. There is a persistent skin and underlying soft tissue defect in the right upper neck with interval increased in size of a mass inferior to the defect, which now measures up to 30 mm, previously 20 mm. Likewise, heterogeneous nodules within the right parotid gland have increased in size. There are fluid collections in the left paravertebral and parapharyngeal regions, the largest of which measures up to 35 mm. The gas within these collections has essentially dissipated. The airways inferior to the tracheostomy tube are patent. The remaining thyroid and remaining salivary glands appear unchanged. There is mild atherosclerotic plaque at the bilateral carotid bifurcations. There is a left subclavian venous catheter. There is multilevel degenerative spondylosis. Head: There is no evidence of intracranial mass or abnormal enhancement. The ventricles are stable in size and configuration. The skull appears unremarkable. | 1.Extensive post-treatment findings with extensive edema and multiple persistent soft tissue defects or fistulas and fluid collections, which may be attributable to radiation necrosis, infection, and/or tumor. Furthermore, a dermal right neck mass and right parotid space nodules that likely represent recurrent tumor have increased in size. A PET may be useful for further characterization of disease extent.2. Diffuse subcutaneous edema may represent anasarca or lymphedema, for example.3. No evidence of intracranial metastases. |
Generate impression based on findings. | Reason: mesothelioma History: s/p extended pleurectomy decortication. 01/2015 CHEST:LUNGS AND PLEURA: Interval changes of a right pleurectomy and decortication, with small residual pneumothorax, and scattered subsegmental atelectasis. A small focus of consolidation and groundglass laterally may represent a small expected postoperative contusion.Mild posterior right lung surface nodularity/thickening, with a small right effusion. No definite measurable pleural disease is seen.A moderate lateral right diaphragmatic defect, through which abdominal fat, liver, and multiple bowel loops are herniated. The diaphragmatic defect is broad-based, without definite evidence of perfusion abnormality to the involved structures.Left lower lobe calcified granuloma. The left lung remains otherwise clear.MEDIASTINUM AND HILA: Moderately enlarged right thyroid lobe, with a hypodense nodule appears similar to the prior exam.The heart is normal in size without pericardial effusion. No visible coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative disease of the 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: 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. | 1. Post-surgical changes of a right pleurectomy and decortication, with small residual hydropneumothorax, and a moderate lateral right diaphragmatic defect, through which abdominal fat, liver, and multiple bowel loops are herniated into the right thoracic cavity. 2. No definite measurable pleural disease is seen.Findings discussed via telephone with Kristy Todd, ordering provider, at 11:45 AM. |
Generate impression based on findings. | Reason: h/o HNC and CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: Multiple calcified granulomata, unchanged.No evidence of pulmonary pleural metastases.MEDIASTINUM AND HILA: There is no evidence of mediastinal or hilar lymphadenopathy.No visible coronary calcifications, although there is mild calcification of the ascending aorta. CHEST WALL: Mild degenerative changes affect the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholecystectomy and surgical clips noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: The pancreas is atrophic with calcifications and a dilated duct, unchanged.RETROPERITONEUM, LYMPH NODES: Mild abdominal aortic calcifications are present.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Mild degenerative changes affect the lumbar spine.OTHER: No significant abnormality noted. | No evidence of metastases, or other significant abnormality. |
Generate impression based on findings. | 60 year-old female patient with history of impaction. Evaluate for structure. Initial spot radiograph of the chest showed no mediastinal widening or pleural effusions. There is a right perihilar nodular opacity that is optimally evaluated on chest CT performed the day prior. A calcified splenic aneurysm was noted.Single contrast evaluation of the esophagus reveal an anterior cervical web that caused obstruction of a 13 mm barium pill (series 4, 16, and cine series 16). The patient reports having a similar sensation of food getting caught in that area of her throat. No additional webs were seen. Additionally, a prominent cricopharyngeus muscle was noted (series 16). A small intermittent hiatal hernia was noted. There was one duodenal diverticulum in the second portion of the duodenum and 4 diverticula in the third/fourth portions of the duodenum.Fluoroscopic evaluation of esophageal peristalsis demonstrated cessation of the primary wave at the level of the aortic arch with proximal escape (series 4).TOTAL FLUOROSCOPY TIME: 3:36 minutes | 1.Anterior cervical esophageal web causing obstruction of a barium pill.2.Small intermittent hiatal hernia without evidence of stricture in the lower esophagus.3.Multiple duodenal diverticula.4.Minor esophageal motility abnormality.5.Small splenic artery aneurysm. |
Generate impression based on findings. | Left cervical LAD with non-diagnostic FNA and left paratracheal mass in the setting of weight loss and history of smoking. There are abnormal left lower neck lymph nodes. For example, a left level 4 lymph node measures 12 x 15 mm and a left supraclavicular lymph node measures 11 x 12 mm. Several other smaller lymph nodes in this region appear pathologic as well, some of which appear hyperenhancing and others cystic. The salivary glands are unremarkable. There is a partially calcified left thyroid nodule that measures up to approximately 20 mm. The mass protrudes into the left tracheoesophageal groove, but does not appear to grossly encroach upon the esophagus or trachea. There appear to be a small amount of secretions within the trachea, however. There is also a hypoattenuating subcentimeter nodule more anterior in the left thyroid lobe. There is atherosclerotic plaque at the carotid bifurcations. There is mild multilevel degenerative spondylosis and osteopenia. The imaged intracranial structures are unremarkable, aside from carotid siphon calcifications. There are bilateral lens implants. There is emphysema in the partially-imaged lungs. | 1. A partially calcified left thyroid nodule that measures up to approximately 20 mm may represent a malignant neoplasm and the extensive left cervical lymphadenopathy likely represents metastatic disease.2. Pulmonary emphysema. |
Generate impression based on findings. | Female, 49 years old s/p adrenalectomy and lymphadenectomy. RFO Trigger: multiple surgical teams. Suspected RFO Location: n/a. Suspected RFO: n/a No unexpected radiopaque foreign bodies. Surgical clip in the right upper quadrant. Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | No unexpected radiopaque foreign bodies. Findings were discussed with attending surgeon, Dr. Grogan, over phone, at 1008 on 2/19/15. |
Generate impression based on findings. | Clinical question: Chronic sinusitis, polyps. Signs and symptoms: As above. Nonenhanced maxillofacial CT: Examination demonstrate extensive chronic pansinusitis.Completely opacified left frontal sinus demonstrate no change since prior exam.Completely opacified bilateral ethmoid air cells demonstrate no significant change.Completely opacified sphenoid sinus demonstrate no interval change.Extensively opacified bilateral maxillary sinuses demonstrate subtle interval improvement with a small pockets of air now visible bilaterally.Extensive postoperative changes of endoscopic functional sinus surgery is noted. There are patent however compromised due to mucosal thickening of bilateral sinonasal windows.Images through the nasal passage demonstrate extensive increased soft tissue density with subtle interval improvement since prior exam.There is very subtle bony remodeling sinuses secondary to excessive disease however without any foci of bony breakthrough.Unremarkable images through the orbits.Bilateral mastoid air cells and middle ear cavities remain well pneumatized and similar to prior exam. | 1.Very extensive chronic pansinusitis as detailed. Minimal interval improvement of maxillary sinus opacification since prior study.2.Extensive postoperative changes of endoscopic functional sinus surgery with compromised however patent bilateral sinonasal windows.3.Mastoid air cells and middle ear cavities remain well pneumatized. 4.Unremarkable images through the orbits. |
Generate impression based on findings. | CT HEAD: There is a stable small focus of subarachnoid hemorrhage in the right sylvian fissure. There is a new small focus of subarachnoid hemorrhage in the right middle temporal sulcus. There is trace layering hemorrhage in the left occipital horn. There is interval resolution of layering hemorrhage in the right occipital horn. There is persistent effacement of the right temporal and parietal sulci. The ventricles and basal cisterns are unchanged in size and configuration. Encephalomalacia is redemonstrated in the pons and right cerebellar hemisphere. There is an age-indeterminate lacunar infarct in the right basal ganglia. Small areas of right MCA territory infarction are otherwise less conspicuous than on the prior MRI due to the technical limitations of CT. There is no midline shift or herniation. There is a mucus retention cyst in the right maxillary sinus. The remaining imaged paranasal sinuses and mastoid air cells are clear. There is an unchanged soft tissue lesion in the right parietal scalp laterally, which is nonspecific. The skull and extracranial soft tissues are otherwise unremarkable. There is evidence of dental disease. A nasoenteric tube is partially imaged. There are bilateral lens implants.CTA HEAD: There is luminal irregularity and narrowing in the cavernous internal carotid arteries due to calcifications, which is severe on the right and moderate on the left. There is a 3 mm apparent outpouching along the lateral aspect of the right cavernous internal carotid artery. The anterior cerebral arteries are patent. There is luminal irregularity of the right M1 branch without high-grade stenosis. There is persistent paucity of the more distal right middle cerebral artery branches. There is severe stenosis of a left MCA branch near the distal bifurcation. There is a prominent right posterior communicating artery and perhaps a hypoplastic left posterior communicating artery. The vertebral arteries and proximal basilar artery are markedly narrow in caliber diffusely. The posterior cerebral arteries are patent. CTA NECK: There is a separate origin of the left subclavian artery, left common carotid artery, and brachiocephalic artery from the arch. The common carotid arteries are normal in course and caliber. There is at least 50% stenosis of the left and at least 60% stenosis of the right internal carotid arteries near the bifurcation. There is severe stenosis of the right external carotid artery near the bifurcation. The left vertebral artery origin is patent. The right vertebral artery is attenuated throughout its course. There is partially-imaged mediastinal lymphadenopathy with scattered foci of calcification. There is multilevel degenerative cervical spondylosis. | 1. Unchanged small subarachnoid hemorrhage in the right sylvian fissure and layering hemorrhage in the left occipital horn, but new small subarachnoid hemorrhage in the right middle temporal sulcus. 2. Apparent occlusion of right MCA branch and stenosis of a left MCA branch near the distal bifurcation, which may be attributable to atherosclerotic disease or other vasculopathy perhaps with superimposed vasospasm. The known small areas of right MCA territory infarction are otherwise better depicted on the prior MRI.3. A 3 mm outpouching along the lateral aspect of the right cavernous internal carotid artery may represent an aneurysm or dysplasia.4. At least 50% stenosis of the left and at least 60% stenosis of the right internal carotid arteries and severe stenosis of the right external carotid artery near the bifurcation. A Doppler carotid ultrasound may be useful for further characterization.5. Diminutive vertebrobasilar system, which also be due to vasculopathy perhaps superimposed upon congenital hypoplasia, and may be related to chronic cerebellar and brainstem infarcts. 6. Partially-imaged mediastinal lymphadenopathy, which may represent neoplasm or granulomatous disease for example. A dedicated chest CT may be useful for further evaluation.Discussed with Dr. Goldenberg at 4:20 PM on 2/19/15. |
Generate impression based on findings. | Reason: active smoking 1/2 PPD x 57 yrs History: none LUNGS AND PLEURA: Sharply marginated 10 x 9 mm right upper lobe nodule image 54 series 5 has not significantly changed as far back as at least 9/16/2008.Scattered scarlike opacities, minimal bronchial wall thickening, and mild emphysema are unchanged.No evidence of lung cancer. MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy.Severe coronary artery calcification is present, and the heart is mildly enlarged.Dense aortic calcifications are noted.Small hiatal hernia noted.Calcified right hilar lymph node.CORONARY ARTERIES: Severe calcification.CHEST WALL: Degenerative changes affect the thoracic spine.UPPER ABDOMEN: Low dose technique markedly limits sensitivity for abdominal pathology. Extensive vascular calcification involving the aorta and its branches. | 1. No evidence of lung cancer.2. Long-term stability of the known right upper lobe nodule which is likely benign.3. Severe coronary artery calcification.Lung-RADS: Category: 2/S (Benign Appearance or Behavior: Nodules with a very low likelihood of becoming a clinically active cancer due to size or lack of growth/Significant - other)RECOMMENDATION: Continue annual screening with LDCT in 12 months. |
Generate impression based on findings. | 30 year old male with history of unexplained iron deficiency anemia and EGD with large hiatal hernia. EGD, colonoscopy, capsule study without bleeding source. Assess for hiatal hernia or gastric diverticulum and small bowel wall mass lesion. ABDOMEN:LUNG BASES: A small sliding hiatal hernia is present.LIVER, BILIARY TRACT: There is agenesis of the left hepatic lobe. The gallbladder appears unremarkable. No biliary ductal dilatation.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: Evaluation of the small bowel is slightly limited by suboptimal distention. Small bowel is of normal caliber without evidence of obstruction. No abnormal wall thickening is identified. There are numerous small foci within both the small bowel and colon which demonstrate high attenuation on both the non-contrast phase and post-contrast phases most consistent with high density ingested enteric contents. No abnormal pooling of contrast on the delayed images. The appendix is well-visualized and is unremarkable. The sigmoid colon is redundant and extends into the right upper quadrant.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: Evaluation of the small bowel is slightly limited by suboptimal distention. Small bowel is of normal caliber without evidence of obstruction. No abnormal wall thickening is identified. There are numerous small foci within both the small bowel and colon which demonstrate high attenuation on both the non-contrast phase and post-contrast phases most consistent with high density ingested enteric contents. No abnormal pooling of contrast on the delayed images. The appendix is well-visualized and is unremarkable. The sigmoid colon is redundant and extends into the right upper quadrant.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Non-enhancing high density foci within the small bowel and colon most compatible with ingested enteric contents, although small polyps cannot be entirely excluded.2.No small bowel masses our source of gastrointestinal bleeding identified.3.Agenesis of the left hepatic lobe.4.Redundant sigmoid colon. 5.Small hiatal hernia. |
Generate impression based on findings. | The lumbar spine is in normal alignment, with a normal lumbar lordosis. There is mild disk narrowing at L4-L5, with diffuse disk desiccation throughout the lumbar spine. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L2-L3 level. There is slight thickening of the cauda equina nerve roots with redundancy despite lack of high-grade central spinal stenosis.At L1-L2, there is left facet arthropathy with trace right foraminal disk protrusion.At L2-L3, there is a trace disk bulge with right foraminal prominence and mild bilateral facet arthropathy as well as ligamentum flavum thickening. There is minimal encroachment upon the inferior foramina. There is mild to moderate right foraminal narrowing.At L3-L4, there is a trace disk bulge with superimposed left foraminal/far lateral disk protrusion. There is overall mild central spinal canal stenosis with slight encroachment upon the lateral recesses. There is mild to moderate right and mild left foraminal narrowing.At L4-L5, there is a mild disk bulge with slight right-sided prominence. There is left greater than right facet arthropathy and ligamentum flavum thickening. There is mild narrowing of the lateral recesses. There is abutment of both descending L5 nerve roots slightly more conspicuous on the left side. There is minimal left and moderate right foraminal narrowing. There is mild to moderate central spinal canal stenosis.At L5-S1, there is prominent bilateral facet arthropathy and ligamentum flavum thickening, much greater on the right. There is a left paracentral annular fissure. There is moderate bilateral foraminal narrowing. There is impingement of the exiting right L5 nerve root which appears slightly thicker than the contralateral side.The partially visualized gallbladder appears somewhat distended although without filling defects. | 1. Overall, mild to moderate multilevel spondylotic changes as detailed above, with greatest degree of disk height loss at L4-L5 although no focal right-sided disk pathology. Mild to moderate central spinal canal stenosis at this level as well as moderate right and mild left foraminal narrowing. Abutment of the right and slight posterior displacement of the left descending L5 nerve roots.2. Moderate bilateral foraminal narrowing at L5-S1 with impingement of the exiting right L5 nerve root. |
Generate impression based on findings. | Tracheostomy dependentVIEW: Chest AP Tracheostomy tube in place. NG tube tip in the stomach. Cardiothymic silhouette normal. Right upper lobe atelectasis has improved. There are new atelectasis involving the left lung in a background of chronic lung disease. | Right upper lobe atelectasis has improved with interval increase atelectasis in the left lung. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of bilateral benign biopsies and breast reduction. Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms can be submitted, then an addendum to this report will be made.Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. Architectural distortion secondary to breast reduction is noted. There is a biopsy clip in the right mid outer breast anterior depth. A round, circumscribed 6-mm mass in the lower outer right breast is benign in appearance and likely represents a lymph node or cyst. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. Benign-appearing mass in the right breast which can be compared to prior, outside imaging if the patient can provide. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 68 years, Female, Reason: r/o mass History: abnormal renal ultrasound at outside clinic. ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Right renal cyst is stable. Prominent common bile duct. No intrahepatic biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: Prominent pancreatic duct without obstructing lesion present.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Two subcentimeter left renal hypodensities are too small to definitively characterize but likely represent cysts. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcification of the aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: Atrophic/surgically absent uterus.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Subcentimeter left renal lesions are too small to characterize but likely represent cysts. No suspicious renal lesions are identified. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of two sisters with breast cancer. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Treated head and neck cancer, now with spiculated lung nodule and adenopathy. Staging mediastinum.RADIOPHARMACEUTICAL: 11.6 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 91 mg/dL. Today's CT portion grossly demonstrates extensive post-surgical changes in the lower midline neck, an approximately 1 cm right apical pulmonary nodule, an enlarged right lower paratracheal lymph node, a tracheostomy tube, a Porta cath in the right atrium and extensive atherosclerotic, including coronary, arterial calcifications.Today's PET examination demonstrates a small but significantly hypermetabolic nodule at the apex of the right upper lung with an SUVmax of 6.3, which is new from previous exam and is consistent with malignancy. There is an enlarged right lower paratracheal lymph node which is also markedly hypermetabolic with an SUVmax of 11.5, new from previous exam, and is consistent with metastatic disease. Several smaller but significantly hypermetabolic lymph nodes are seen in right superior anterior mediastinum which are also new and consistent with additional mets with an SUVmax of 5.6. No suspicious FDG avid lesions are seen in the left chest. No suspicious FDG avid activity is seen in the neck, abdomen or pelvis. There is mild bilateral axillary lymph node activity consistent with inflammation. The previous hypermetabolic epiglottic lesion has resolved. | 1.Small but new hypermetabolic right apical lung nodule compatible with malignancy. Given the location and ipsilateral metastatic pattern, this may represent a new primary lung cancer although metastatic head and neck cancer is also conceivable. 2.Hypermetabolic hilar and right mediastinal lymph nodes are also new and consistent with metastatic disease 3.No FDG avid tumor currently in the neck, left chest, abdomen, pelvis or the visualized skeleton. |
Generate impression based on findings. | Early stage vulvar cancer, status post modified radical vulvectomy for bilateral inguinal sentinel lymph node dissection. RADIOPHARMACEUTICAL: The perineum was prepared in a sterile manner. A total of 0.493 mCi Tc-99m filtered sulfur colloid was injected into six peri-incisional sites by the attending surgeon, Dr Tenney, under the direct supervision of the authorized radioactive materials user, Dr Appelbaum. A focus of increased activity is noted in left low medial inguinal region, representing the sentinel node(s). No drainage was noted on the right. This region was marked with an indelible marker.Diffuse hepatic activity indicates mild venous passage of radiotracer. | Left lower medial inguinal drainage is visualized. No drainage is visualized on the right. The patient was subsequently sent for intra-operative localization. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of bilateral breast reduction. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Calcification and architectural distortion in the right upper breast, mid left breast, and upper left breast are compatible with evolving fat necrosis and oil cysts. No suspicious masses, microcalcifications or areas of architectural distortion are present. | Evolving fat necrosis and oil cysts in the breast bilaterally. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Elevated LFTs, evaluate for clot, history of DVT, on Coumadin LIVER: Measures 11.9 cm. Parenchyma not well assessed due to patient's difficulty breath-holding and changing position but no liver lesion delineated. Main portal vein patent with normal directional flow, velocity measures 20 to 30 cm/sec. Left and right portal veins patent with normal directional flow, velocities measure 20 cm/sec and 20 cm/sec, respectively. Patent hepatic arteries. Common hepatic artery peak systolic velocity measures 90 cm/sec. Peak systolic velocities of left and right hepatic arteries measure 50 cm/sec and 70 to 80 cm/sec, respectively. Resistive indices of common, left and right hepatic arteries measure 0.75, 0.74, and 0.78-0.80, respectively. Visualized IVC patent. GALLBLADDER, BILIARY TRACT: Status post cholecystectomy. No intrahepatic or extrahepatic biliary ductal dilatation.PANCREAS: Not well seen due to overlying bowel gas.SPLEEN: Measures 6.9 cm.KIDNEYS: Right kidney measures 9.5 cm and left kidney measures 9.5 cm. Increased renal cortical echogenicity, may reflect underlying medical renal disease. No hydronephrosis. No shadowing intrarenal echogenic focus seen to suggest underlying nephrolithiasis.VASCULAR: Main portal vein patent with normal directional flow, velocity measures 20 to 30 cm/sec. Left and right portal veins patent with normal directional flow, velocities measure 20 cm/sec and 20 cm/sec, respectively. Patent hepatic arteries. Common hepatic artery peak systolic velocity measures 90 cm/sec. Peak systolic velocities of left and right hepatic arteries measure 50 cm/sec and 70 to 80 cm/sec, respectively. Resistive indices of common, left and right hepatic arteries measure 0.75, 0.74, and 0.78-0.80, respectively. Visualized IVC patent. | Patent hepatic vasculature.Increased renal cortical echogenicity, may reflect underlying medical renal disease. |
Generate impression based on findings. | 43-year-old with history of left breast fibroadenoma and family history of breast cancer. Status post left excisional biopsy for focal atypia and PASH. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Expected post surgical changes in the left breast from the excisional biopsy. Stable focal asymmetry in the left upper breast near 12:00. Benign appearing lymph node is projected over the left axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Screening MRI will be due this summer as well. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | T1N2B palate squamous cell carcinoma status post resection and chemotherapy and subsequent recurrence treated with resection. Extensive dental streak artifact limits the assessment of the oral cavity and oropharyngeal regions. Otherwise, there is a defect in the left tongue base with nonspecific partially-obscured soft tissue along the surgical margins. There appears to be slight interval increase in size of a left level 2 lymph node that measures 8 mm in short axis, previously 7 mm. The thyroid and major salivary glands appear unchanged. There is mild plaque at the carotid bifurcations and there is a retropharyngeal internal carotid artery. The osseous structures are unchanged. The airways are patent. There is mild mucosal thickening in the maxillary sinuses. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | 1. Extensive dental streak artifact limits assessment. Otherwise, a defect in the left tongue base with partially-obscured ill-defined soft tissue along the surgical margins is nonspecific.2. Slight interval increase in size of a left level 2 lymph node that measures 8 mm in short axis, previously 7 mm, which is nonspecific. |
Generate impression based on findings. | Female 90 years old Reason: pubic ramus fracture History: pubic ramus fracture. Again seen is a fracture through the right superior pubic ramus and ischium and a right sacral alar fracture, with callus formation indicating interval healing. The bones are demineralized. An IVC filter is noted. | Fractures of the right superior pubic ramus, right ischium and right sacrum as described above with interval healing. |
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