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Generate impression based on findings. | Evaluate fecal burdenVIEW: Abdomen AP Multiple gaseous distention of bowel loops without obstruction. Mild amount of fecal burden. No pneumatosis or pneumoperitoneum. | Mild amount of fecal burden. |
Generate impression based on findings. | Cellulitis and edema. Evaluate for necrotizing fasciitis There is extensive edema throughout the entire right upper extremity, most prominent in the forearm. There is predominantly subcutaneous edema from the axilla to the elbow, with increasing fascial edema and skin thickening throughout the volar aspect of the forearm. The flexor muscles of the forearm are slightly increased in size compared to prior and of lower attenuation, suggestive of edema or possible necrosis. Evaluation for necrosis is limited on noncontrast CT. No discrete fluid collections are seen to suggest abscess formation. No soft tissue gas is noted.A nodular density in the right lung apex described on prior chest CT is unchanged. | 1. Increasing fascial edema and skin thickening in the right forearm, which likely infectious in etiology. Early necrotizing fasciitis may appear similar to this and cannot be excluded.2. Increased size and decreased attenuation of the flexor musculature of the forearm, which may represent edema or possible necrosis, though differentiation is limited on non-contrast CT. Findings discussed by telephone with the covering physician Dr. N. Desai at 1030am on 2/19/15 |
Generate impression based on findings. | Male 34 years old Reason: significant weight loss and dysphagia. Recent diagnosis of Achalasia. Rule out intraabdominal advanced malignancy. History: dysphagia and weight loss ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No biliary ductal dilatation or focal hepatic mass.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: Mildly thickened esophageal wall.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 | Normal examination. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of basal cell carcinoma of the nose. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. Circumscribed mass at the 2 o'clock position of the left breast appears unchanged from the prior examination and is compatible with intramammary lymph node. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | ReintubationVIEW: Chest AP ET tube tip at the level of the thoracic inlet. NG tube tip in the stomach. Right central line in place. Cardiothymic silhouette cannot be evaluated. Diffuse atelectasis bilaterally not significantly changed. No pleural effusion or pneumothorax. | ET tube tip at the level of the thoracic inlet. |
Generate impression based on findings. | 38 years, Female. Reason: S/P ex-lap, aborted HIPEC. Evaluate for ileus History: Same Midline abdominal staples again noted. Central venous catheter tip at the superior cavoatrial junction.Centralized loops of gas distended small bowel. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and an additional left MLO were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. Scattered coarse calcifications are noted bilaterally and unchanged from prior examinations. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | 55-year-old male with history of testicular seminoma status post orchiectomy. Also history of PE. CHEST:LUNGS AND PLEURA: Scattered nonspecific micronodules including right middle lobe pleural based nodule (series 5, image 63) not significantly changed. No pleural effusions or suspicious masses. MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Retroaortic course of the left renal vein. RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate degenerative changes of the visualized thoracolumber spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Moderate degenerative changes of the visualized thoracolumber spine.OTHER: No significant abnormality noted | 1.No specific evidence of metastatic disease. |
Generate impression based on findings. | The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. Areas of T2/FLAIR hyperintensity in the subcortical and deep white matter bilaterally without significant interval change, consistent with probable chronic small vessel ischemic changes. There is no diffusion abnormality. No extra-axial fluid collection is identified. Mild scattered sulcal FLAIR hyperintensity likely relates to sedation/oxygenation.There is poor visualization of the distal internal carotid artery flow-voids as well as the M1 segment and right A1 segment. There are prominent ganglia bilaterally consistent with known lenticulostriate vasculature. Normal flow-voids are demonstrated in the remainder of the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening in the maxillary sinuses as well as moderate patchy opacification of the left greater than right ethmoid air cells. | 1. No acute infarct. Similar pattern of probable chronic small vessel ischemic changes within the white matter bilaterally.2. Incomplete evaluation of the vasculature as MRA was not performed. Grossly, internal carotid artery flow-voids as well as bilateral M1 and right A1 segments are not well visualized, similar to previous. |
Generate impression based on findings. | 72 years, Female, Reason: Parastomal hernia status History: Abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cirrhotic liver morphology. Right hepatic hypodensity is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule measured 1.1 cm is unchanged (3/46)KIDNEYS, URETERS: Stable right renal cysts. Additional smaller cysts are unchanged.RETROPERITONEUM, LYMPH NODES: Aneurysmal dilatation of the lower thoracic aorta is unchanged measuring 4.0 cm (80297/79), previously 3.9 cm. BOWEL, MESENTERY: Small hiatal hernia. Diverticulosis with persistent fascial thickening along the left paracolic gutter.BONES, SOFT TISSUES: There is a midline incisional hernia containing two loops of small bowel which is slightly increased since prior exam. A right parastomal hernia containing multiple bowel loops is also increased. No evidence of obstruction.OTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: Fibroid uterus. Left adnexal cyst is unchanged measuring 1.9 cm (3/112), previously 1.8 cm.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Moderate atherosclerotic calcifications of the visualized spine.OTHER: No significant abnormality noted | 1.Incisional and right parastomal hernias containing bowel loops have increased. No evidence of obstruction.2.Stable thoracic aortic aneurysm.3.Stable left adrenal nodule. |
Generate impression based on findings. | PICC placementVIEW: Chest AP ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Left central line with tip in the SVC. Left upper extremity PICC with tip in the right atrium. Cardiothymic silhouette normal. Patchy atelectasis in the right upper lobe and left lower lobe. No pleural effusion or pneumothorax. | Patchy atelectasis in the right upper lobe and left lower lobe. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of paternal grandmother and aunts with breast cancer. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. 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: NSC - Screening Mammogram. |
Generate impression based on findings. | Reason: Recent worsening ground glass opacities on CT, assess for progression or resolution History: Cough \T\ SOB LUNGS AND PLEURA: Continued increase in scattered patchy ground glass opacities and bronchial wall thickening throughout the lungs.Redemonstration of bilateral basilar consolidation, slightly decreased on the left and increased on the right, with air bronchograms suggestive of aspiration/infection.No pleural effusions.MEDIASTINUM AND HILA: The heart is mildly enlarged, with minimal pleural fluid/thickening, stable. Moderate coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: Redemonstration of bilateral axillary lymphadenopathy, similar in appearance to the previous exam, and not seen on the prior exam dated 07/2014.Mild degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Continued interval increase in scattered ground glass opacities, bronchial wall thickening, basilar consolidation. Findings may represent pneumonia including viral pneumonia, or may relate to graft versus host disease.2.Bilateral axillary lymphadenopathy, raising the question of treatment related lymphoma. |
Generate impression based on findings. | Male 57 years old Reason: eval for cirrhosis, hepatic mass History: suspect EtOH cirrhosis ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Nodular liver morphology with widening of the fissures consistent with cirrhosis. No focal enhancing hepatic masses. No ascites. Prominent splenorenal and paraesophageal varices are present. Intrahepatic portal vein is diminutive. Cholelithiasis without acute cholecystitis. SPLEEN: Spleen size at the upper limit of normal.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative changes of the thoracic spine.OTHER: No significant abnormality noted | 1.Cirrhotic liver morphology with prominent splenorenal and paraesophageal varices.2.No focal hepatic mass. |
Generate impression based on findings. | Worsening sinusitis on 2/13 CT, assess for progression or resolution. There is continued increase in diffuse opacification of the paranasal sinuses with mucosal thickening and fluid, particularly within the left sphenoid and maxillary sinuses. The olfactory recesses are opacified. 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. The nasopharynx and facial soft tissues appear to be unremarkable. There are bilateral lens implants. There is increased opacification of the left mastoid air cells and new opacification of the left middle ear cavity. There is probable cerumen in the left external auditory canal. There is nonspecific periventricular cerebral white matter hypoattenuation, which may be related to small vessel ischemic disease. There are bilateral lens implants. | 1. Overall continued slight interval progression of acute sinusitis.2. Partial opacification of the left mastoid air cells and tympanic cavity may represent otomastoiditis. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and additional right MLO view were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. A focal asymmetry in the left upper outer breast appears unchanged from 2005. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | 57-year-old female status post robotic hysterectomy for endometrial cancer, now with pelvic swelling, evaluate for lymphocele. 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: Bilateral prominent extrarenal pelves, similar to prior. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Small soft tissue nodules in the anterior abdominal subcutaneous fat may be related to injections.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus is surgically absent. There is a small amount of free fluid in the pelvis without loculation.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: There is a well-defined fluid collection just posterior to the right superior pubic ramus (series 5, image 136) measuring 2.6 x 3.7 cm which compresses the right external iliac vein and is compatible with a postoperative lymphocele. | 1.Status post hysterectomy. Small amount of free fluid in the pelvis may be postsurgical. No lymphadenopathy.2.Lymphocele compressing the right common external iliac vein. |
Generate impression based on findings. | 64 years, Male, Reason: evaluate vasculature to support kidney transplant History: weak pulses. Prior transplant in 2008 ABDOMEN:LUNG BASES: Cardiomegaly with small pericardial effusion.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: A 1.7-cm left lower pole lesion is of higher attenuation than water and is incompletely characterized. There is an additional 1.9-cm right lower pole lesion which is also higher attenuation than water and incompletely characterized. Kidneys are atrophic bilaterally. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcifications of the aorta. There are mild atherosclerotic calcifications of the right common iliac and minimal calcifications of the left common iliac. There are minimal calcifications of the bilateral internal iliac arteries.Scattered small retroperitoneal lymph nodes.BOWEL, MESENTERY: Small ventral hernia.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate abdominal pelvic ascites. Anasarca.PELVIS: MalePROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Mildly enlarged inguinal lymph nodes. Mildly enlarged right internal iliac nodes adjacent to transplant kidney with a reference measuring 1.6 x 1.1 cm (3/125).BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mild degenerative changes the visualized spine with grade 1 antral listhesis of L5 relative to S1.OTHER: Enlarged heterogeneous failed transplant in the right iliac fossa. | 1.Vasculature as described above.2.Moderate abdominopelvic ascites.3.Failed transplant in the right iliac fossa. |
Generate impression based on findings. | Recent heart transplant presenting with new onset hypoxia and abnormal chest CT. The comparison chest CT performed on 2/18/2015 demonstrates small bilateral pleural effusions as well as groundglass and consolidative lesions in the right lung base.The ventilation images show a uniform distribution of activity on single-breath and wash-in images. There is no abnormal Xe-133 retention in the lungs during the wash-out phase. Incidental note is made of mild retention of Xe133 in the liver which may represent hepatic steatosis.The perfusion images demonstrate multiple medium and large wedge shaped mismatched perfusion defects in the periphery of the right greater than left lung. Mismatched perfusion defects are particularly noted in the right upper and lower lobes as well as the medial left lower lobe. | High probability for pulmonary emboli.Findings relayed to Dr. Schurle (pager 4279) of the primary service by Dr. Veronesi of Radiology at the time of this dictation. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, 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: NSC - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of colon cancer at age 54. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. Focal asymmetry in the left lower outer breast is unchanged from 2007 and likely represents intramammary lymph node. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | The procedure, indications, benefits, risks/complications and alternatives were described to the patient and informed consent was obtained.The patient was placed in an oblique left lateral decubitus decubitus position and the lumbar region was prepped with Betadine, draped and anesthetized with 1% lidocaine.Using fluoroscopic guidance, a 22 gauge x 3-1/2 inch spinal needle was localized into the thecal sac at the L2-3 level. 14 cm of clear cerebrospinal fluid was obtained and the sample was sent to cytopathology for diagnostic analysis. The needle was removed and hemostasis was achieved.The patient tolerated the procedure well with no immediate complications. | Successful fluoroscopically guided lumbar puncture without immediate complication. |
Generate impression based on findings. | 10-year-old male with distal right tibia fracture s/p cast removal.VIEWS: Right ankle AP and lateral (two views) 2/19/2015 at 1021 Again seen is an oblique fracture through the distal tibial diaphysis with persistent lateral displacement of the distal fracture fragment status post cast removal. Increased periosteal reaction and sclerosis about the fracture line are compatible with interval healing. Diffuse osteopenia is again noted. | Healing oblique fracture of the distal tibial diaphysis, unchanged in alignment as described above. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of maternal cousins with breast cancer. Two standard digital views of both breasts with additional bilateral CC, an additional left MLO, and two additional right 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. Right chest wall pacemaker generator is noted. Scattered benign arterial, ductal, and skin calcifications are noted. No suspicious masses, microcalcifications or areas of architectural distortion are present. | Benign appearing calcifications, but no mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Ms. Smith is a 60 year old female with a personal history of right cyst aspiration in 2013. She has no current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. Benign lymph nodes project over both axillae. | 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. | Male 61 years old Reason: History metastatic prostate cancer on trial, assess disease extent History: none CHEST:LUNGS AND PLEURA: Right upper lobe linear subsegmental atelectasis/scarring unchanged. Right lower lobe linear atelectasis, unchanged. Persistent elevation of the right hemidiaphragm.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy. Normal heart size without pericardial effusion. Mild coronary artery calcifications.CHEST WALL: Post surgical changes from upper thoracic spine fixation hardware. Stable lytic lesions within the thoracic vertebral bodies. Unchanged expansile lytic lesion in the right posterior fourth rib.ABDOMEN:LIVER, BILIARY TRACT: Subcentimeter hypodense lesion in the left hepatic lobe is unchanged and too small to characterize.SPLEEN: Unchanged nonspecific splenic hypodensity.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter right renal hypodensity is too small to characterize but unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Stable lytic lesions within the lumbar vertebral bodies. OTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: Status post prostatectomyBLADDER: No significant abnormality notedLYMPH NODES: Reference left external iliac node measures 2.9 x 1.8 cm (series 3, image 159), previously 2.8 x 1.9 cm .Midline nodule posterior to the bladder measures approximately 2.9 x 2.4 cm (series 3, image 183), previously 2.6 x 2.1 cm, however, the lymph node was largely obscured by streak artifact on the previous exam contributing to the slight increase in size.Left common iliac node measures 2.8 x 1.8 cm (series 3, image174), previously 3.0 x 1.8 cm. No new lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Extensive osseous involvement in the pelvis with healed left inferior pubic ramus fracture, not significantly changed. Right hip arthroplasty.OTHER: No significant abnormality noted | 1.Stable pelvic lymphadenopathy.2.Diffuse osseous metastases are grossly unchanged from prior exam, however, they are better characterized on bone scan from same day. |
Generate impression based on findings. | 18 year-old female with LP shunt. Please assess shunt setting.VIEW: Abdomen lateral (one view) 2/19/2015 at 1048 Codman Hakim valve setting is approximately 110 mm of water. LP shunt catheter enters the spine at approximately L3/L4 and terminates in the pelvis. No kinking or discontinuity is seen in the visualized radiopaque portions of the shunt. Nonobstructive bowel gas pattern. Average fecal burden. | Codman Hakim valve setting is approximately 110 cm of water. No evidence of LP shunt malfunction. |
Generate impression based on findings. | Male 25 years old Reason: hx of testicular cancer s/p RPLND eval for mets History: hx of testicular cancer s/p RPLND eval for mets CHEST:LUNGS AND PLEURA: No suspicious nodules or masses.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No lymphadenopathy.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: Status post left orchiectomy. | Status post left orchiectomy without evidence of metastatic disease. |
Generate impression based on findings. | 66 year old male with history of HCC and HBV, restaging imaging. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: The previously described large right hepatic lobe mass (series 9, image 27) measures 7.3 x 9.7 cm on the arterial phase, measured 7.9 x 10.6 cm on 7/31/2014 arterial phase and measured 7.0 x 9.7 cm on 11/10/2014 portal venous phase. Previously described posterior right hepatic lobe segment 7/6 lesion (series 9, image 33) measures 0.5 x 0.5 cm, measured 0.5 x 0.5 cm on 7/31/2014 arterial phase and 0.5 x 0.5 cm on 11/10/2014 portal venous phase. Previously described segment 4 a lesion (series 11, image 32) measures 1.4 x 2.5 cm, measured 1.4 x 2.5 cm on 7/31/2014 and 1.4 x 2.4 cm on 11/10/2014. No new lesions are identified.The main portal vein is patent. Again, invasion of the right portal vein is again noted.Perihepatic fluid is stable.SPLEEN: Splenomegaly.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter hypoattenuating left renal lesion is too small characterize.RETROPERITONEUM, LYMPH NODES: Reference aortocaval lymph node (series 11, image 51) measures 0.8 x 1.1 cm, measured 0.8 x 1.1 cm previously. Unchanged appearance of the enlarged gastrohepatic lymph nodes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Multifocal HCC, stable to slightly decreased in size. 2.Stable aortocaval and gastrohepatic lymphadenopathy. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. 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, cleavage view, 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. A cluster of calcifications seen in the left central upper breast at middle depth appear to change in morphology between the MLO and CC views and are likely benign, but can be compared to prior imaging. No suspicious masses, microcalcifications or areas of architectural distortion are present. | Cluster of benign-appearing calcifications in the left breast which can be compared to prior, outside images if the patient can provide. 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. | Pain Right wrist: No fracture or malalignment. No significant abnormality noted.Left shoulder/AC joint: No fracture or malalignment. Minimal osteoarthritis affects the left acromioclavicular joint. No significant animality otherwise noted. | Minimal osteoarthritis of the left acromioclavicular joint. No fracture or malalignment. |
Generate impression based on findings. | There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is complete opacification of the left maxillary sinus with partial opacification of the right maxillary sinus. There is mild bilateral scattered ethmoid air cell mucosal thickening. There is mild right sphenoid sinus mucosal thickening. There is mild right frontal subgaleal soft tissue thickening which is mildly hyperdense. However, the subcutaneous tissue in this region is intact and shows no induration. The skull and extracranial soft tissues are otherwise unremarkable. | 1.Mild right frontal subgaleal scalp soft tissue edema and/or hematoma with no acute intracranial hemorrhage or skull fracture.2.Sinus mucosal thickening as described above. |
Generate impression based on findings. | History preseptal cellulitis and sinusitis; now with worsening right eye swelling. There are postoperative findings related to right dacryorhinocystostomy. There is persistent right preseptal stranding and swelling as well as enlargement of the right lacrimal sac. Otherwise, there is no evidence of postseptal extension of abscess formation. The globes and ocular adnexa are intact. There are extensive postoperative findings related to sinonasal surgery with persistent scattered sinonasal opacification. There is diffuse sclerosis and thickening of the paranasal sinus walls. There is nasal septal deviation towards the left. The imaged intracranial structures are unremarkable. | 1. Persistent right preseptal stranding and swelling is suggestive of cellulitis, but no evidence of postseptal extension of abscess formation.2. Findings compatible with chronic dacrocystitis. 3. Postoperative findings related to endoscopic sinus surgery with extensive chronic sinusitis. |
Generate impression based on findings. | History of Hodgkin lymphoma with new mass at left submandibular area. Evaluate for tumor recurrence.RADIOPHARMACEUTICAL: 8.6 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 96 mg/dL. Today's CT portion grossly demonstrates mucosal thickening/retentions cysts of the left maxillary sinus. Today's PET examination demonstrates no significantly FDG avid lesion to indicate new tumor. Specifically, no suspicious activity is identified in the submandibular regions.Note is made of extensive benign brown fat metabolism in the bilateral neck, chest, and right upper abdomen. | No abnormal FDG avid lesion is identified. |
Generate impression based on findings. | Female 64 years old Reason: pre-op History: pain. There is severe osteoarthritis of the right hip joint space narrowing and tricompartmental osteophytes. No acute fracture or dislocation.AP view of the pelvis shows moderate to severe osteoarthritis of the left hip and pubic symphysis. There is severe degenerative arthritic changes of the lower lumber spine. | Severe osteoarthritis of the right hip described above. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of right breast benign biopsies. 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 heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Scattered clusters of coarse, benign-appearing calcifications appear unchanged from the prior examination. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | 10-year-old male with traumaVIEW: Chest AP (one view), pelvis, AP (one view), cervical spine, AP and lateral (two views) 2/19/15 10:46 Chest: The cardiothymic the silhouette is normal. No focal pulmonary opacity or pneumothorax.Pelvis: No fracture or malalignment. The femoral heads are well directed with respect to the acetabula.Cervical spine: The cervical spine is visualized to C6. The prevertebral soft tissues are within normal limits. Vertebral body heights and disk spaces are maintained. | Note that the cervical spine is only visualized through C6. If clinically indicated repeat cervical spine radiographs could be obtained for further evaluation. The remainder of the examination is normal. |
Generate impression based on findings. | On anatomic imaging the foramen magnum appears widely patent. The right cerebellar tonsil extends 7 mm below the level of foramen magnum while the left only extends 3 mm. However, both cerebellar tonsils retain a very rounded morphology and there is no significant crowding at this level. CSF flow imaging demonstrates biphasic CSF flow both ventrally and dorsally within the foramen magnum although somewhat asynchronous and perhaps less robust dorsally. This appearance is similar to that of the prior exam. Incidental note is made of a developmental anomaly involving the cerebellum with extension of posterior superior cerebellar folia across the midline. A primary fissure is identified. The fastigial recess may be minimally rounded.There is mild nonspecific prominence of the lateral ventricles right greater than left side. The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There is a stable small focus of T2/FLAIR hyperintensity along the posterior lateral aspect of the left atrium, with minimal nodular appearance on the T2 weighted images There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are otherwise within normal limits. There is a prominent left node of Rouviere which is most likely reactive in a patient of this age.The cervical spine is in normal alignment, with straightening of the normal cervical lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine. | 1. Stable appearance of foramen magnum and rounded cerebellar tonsils, with the right extending 8 mm below the level the foramen magnum without significant crowding. Stable appearance of CSF flow which appears slightly asynchronous and more robust ventrally at this level.2. Redemonstration of cerebellar developmental anomaly, likely a mild rhombencephalosynapsis.3. Small focus of stable nonspecific T2/FLAIR hyperintensity along the left atrial margin.4. Unremarkable MRI of the cervical spine |
Generate impression based on findings. | 69 year old status post benign right breast biopsy. Chronic nipple inversion. Three standard views of both breasts and right spot compression views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Numerous bilateral benign calcifications are present. Multiple biopsy clips are also stable. An area of questioned distortion near the right 3:00 disperses with compression views. Bilateral benign morphology masses and asymmetries are stable. 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. | Male 59 years old; Reason: assess prosthesis History: S/P DRUJ arthroplasty Again seen are postoperative changes of a distal ulna resection with a long stem ulnar prosthesis and distal radial side plate and screw device. The alignment is unchanged. There is no radiographic evidence of hardware complication.Osteoarthritic changes are seen at the wrist and elbow. | Stable postoperative changes. |
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 heterogeneously dense, which may obscure small masses. In the center of the left breast at middle depth, there is an area of architectural distortion best seen on MLO view. The right breast appears normal. | Architectural distortion in the left breast for which spot compression views and possible ultrasound is recommended.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EC - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Bilateral hip pain Osteoarthritis affects the hips bilaterally, moderate to severe on the right and mild on the left. No fracture or malalignment is present. | Osteoarthritis of the hips bilaterally, right greater than left. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of left breast aspiration. 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. Previously seen asymmetry in the left lower outer breast is no longer visualized. 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. | 2-year-old male status post LIJ central line removal. VIEW: Chest AP (one view) 2/19/2015 1123 ET tube tip between thoracic inlet and carina. Feeding tube tip in the stomach. Left upper extremity PICC tip in the right atrium. Left internal jugular central venous catheter has been removed. Normal cardiothymic silhouette. Patchy right upper lobe and left lower lobe atelectasis, unchanged. No pleural effusion or pneumothorax. | 1.Left upper extremity PICC tip in right atrium.2.Unchanged patchy right upper and left lower lobe atelectasis. |
Generate impression based on findings. | Left shoulder pain No fracture or malalignment is present. No significant degenerative changes are noted. No soft tissue calcifications to suggest calcific tendinosis are evident. | No specific findings to account for the patient's pain. |
Generate impression based on findings. | Male; 55 years old. Reason: aki, concern for obstruction assess for hydronephrosis History: aki, hematuria, patient passing blood clots into Foley catheter bag. RIGHT KIDNEY: The right kidney measures 13.4 cm in length. The renal parenchyma is echogenic. A 0.1 x 0.9 x 0.5 cm nonobstructing stone is seen in the lower pole of the kidney. There is mild to moderate hydronephrosis.LEFT KIDNEY: The left kidney measures 14.1 cm in length. The renal parenchyma is echogenic. There is mild to moderate hydronephrosis. No shadowing renal stone is identified.URINARY BLADDER: The bladder is decompressed by Foley catheter. The bladder wall is thickened measuring 1.5 cm. Echogenic debris is seen layering in within the bladder. This limits the evaluation of the bladder for underlying lesion.OTHER: Increased echogenicity of the incompletely imaged liver suggested. | 1.Bilateral mild to moderate hydronephrosis. No obstructing renal stone, nonobstructing right intrarenal stone.2.Thickened bladder wall with layering echogenic material seen in bladder. Given the patient's history, the material within the bladder likely represents hemorrhage and clot. |
Generate impression based on findings. | Bilateral knee pain Mild osteoarthritis affects the knees bilaterally, without significant interval change. No joint effusion is evident in either knee. No acute abnormality is otherwise evident. | Mild osteoarthritis of the knees bilaterally. |
Generate impression based on findings. | 49 years, Male, Reason: evaluate for disease progression. please compare to 11/25/14 and 9/9/14 CT scans History: stage IV RCC on pazopanib. CHEST:LUNGS AND PLEURA: No focal consolidation or pleural effusion.Micronodule along the minor fissure is stable and may represent an intrapulmonary lymph node. No suspicious nodules or masses.MEDIASTINUM AND HILA: Small mediastinal nodes are unchanged. No hilar lymphadenopathy. Left prevertebral lymph node is decreased in size measuring 1.5 x 1.6 m (3/87), previously 2.5 x 1.8 cm.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy.RETROPERITONEUM, LYMPH NODES: Left periaortic mass along the left hemidiaphragm measures 3.5 x 1.1 cm (3/97), previously 4.5 x 1.8 cm.Superior aortacaval mass measures 2.8 x 2.1 cm (3/1 R1), previously 3.3 x 3.2 cm.Retrocaval mass measures 2.0 x 1.5 cm (3/107), previously 2.9 x 1.9 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lucent lesion in L1 vertebral body stable.OTHER: No significant abnormality noted. | Improved lymphadenopathy. No new sites of disease. |
Generate impression based on findings. | Male 36 years old; Reason: Pt. injured his right hand with the car door. R/O fracture of the right thumb No fracture or malalignment is evident. No significant abnormality is otherwise noted. | No fracture or malalignment. There is continued concern for fracture, dedicated first digit radiographs may be considered. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of left breast cyst removed in 1996. 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. Scar marker noted over left breast. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | The procedure, indications, benefits, risks/complications and alternatives were described and informed consent was obtained from patient's daughter Ms. McGee over the telephone.The patient was placed in left lateral decubitus position in the lumbar region was prepped with Betadine, draped and anesthetized with 1% lidocaine. Using fluoroscopic guidance, a 22 gauge x 3-1/2 inch spinal needle was attempted to be at the L2-3, and L3-4 levels levels without success as the patient was very agitated and kept moving despite of repeatedly giving instructions to remain still. The primary caretaker medical team was present during the procedure, who prescribed Ativan, without much benefit. A radiology technologist was present during the procedure to help calm the patient, however the patient remained agitated and kept moving.Finally, in consultation with the patient's physician Dr. Xuan Han (who was present during the entire procedure), the exam was terminated after multiple unsuccessful attempts. | Unsuccessful attempted lumbar puncture as described above. Examination with anesthesia support can be considered if clinically indicated.Total fluoroscopy time is 2.1 minutes. |
Generate impression based on findings. | 15-year-old male with history of small bowel obstruction and increased NG tube output.VIEWS: Abdomen supine and erect (two views) 2/19/2015 at 1115 Nonobstructive bowel gas pattern. No pneumatosis, free air, or portal venous gas. Average fecal burden. Feeding tube tip in the stomach. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Maternal grandmother with history of ovarian cancer. 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, 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. | 61-year-old with history of right lumpectomy for DCIS in 2012. History of right oncoplastic surgery and left breast reduction. Prior history of left lumpectomy for DCIS in 2004. Both surgeries were followed by radiation therapy. Three standard views of both breasts and right lumpectomy magnification views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No new dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Bilateral post surgical changes are stable. Bilateral benign calcifications are present.Benign appearing lymph nodes are projected over both axillae. | 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. | Total shoulder arthroplasty in 2006 Right wrist: The bones are demineralized. There is progression of the scapholunate advanced collapse deformity, with further widening of the scapholunate interval and proximal migration of the capitate. There is severe narrowing of the radioscaphoid articulation. The ossicle distal to the ulna compatible with an old fracture is unchanged. Faint linear calcifications indicating underlying CPPD are progressed compared to prior.Right shoulder: The total shoulder arthroplasty device is situated in near-anatomic alignment without radiographic evidence of hardware complication or significant interval change compared to the study in 2012. The narrowing of the subacromial interval is similar to prior as well. Heterotopic ossification is again noted along the inferior aspect of the joint. | 1. Progressed extensive degenerative changes of the wrist.2. Stable appearance of the right total shoulder arthroplasty. |
Generate impression based on findings. | Male 70 years old; Reason: progressive weakness and demyelinating disease, assess for occult malignancy CHEST:LUNGS AND PLEURA: Left basilar coarse calcification, likely related to prior granulomatous disease. No suspicious lung nodule seen.MEDIASTINUM AND HILA: Subcentimeter pretracheal lymph node.CHEST WALL: Right chest wall port with tip near cavoatrial junction. Bilateral left greater than right gynecomastia.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Mild relative prominence of pancreatic duct at level of pancreatic neck/proximal body, measuring up to 2 mm, but remains within the limits of normal. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple bilateral hypoattenuating renal lesions, majority of which are too small to characterize, largest is a left-sided upper pole 1.7 cm lesion that does not measure simple fluid with associated Hounsfield units ranging from 21 to 40, indeterminant.RETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerotic disease. Subcentimeter retroperitoneal and inguinal lymph nodes.BOWEL, MESENTERY: Beyond splenic flexure, colon not well distended, making evaluation for underlying wall thickening suboptimal, portions of ascending colon also underdistended.PELVIS:PROSTATE, SEMINAL VESICLES: Prostate gland measures up to 4.8 cm in transverse dimension. BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes of spine, bilateral hip degenerative disease. Scattered subcentimeter sclerotic foci, for example, in proximal right femur, most likely bone islands. Decreased osseous mineralization. | 1. Indeterminate 1.7 cm left renal lesion, may be a complex cyst but minimally enhancing cystic neoplasm not entirely excluded based on this nondedicated exam. Further evaluation with dedicated sonography or MRI with and without IV contrast may be considered. |
Generate impression based on findings. | Please note for the purposes of numbering, there are 5 lumbar vertebral bodies with hypoplastic ribs articulating with L1. Vertebral body heights are maintained. There is mild anterolisthesis of L4 on L5. Alignment is otherwise maintained. There is no acute fracture. Degenerative changes are seen at multiple levels with vacuum disk phenomena at T11-T12, L3-L4, L4-L5, and L5-S1.Multilevel degenerative changes are seen, as describe below:At L1-2 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is disk space narrowing, mild disk bulge, and ligamentum flavum thickening with minimal spinal canal narrowing and mild bilateral neural foramina narrowing. At L3-4 there is mild disk bulge and ligamentum flavum thickening with minimal spinal canal narrowing and mild to moderate bilateral neural foramina narrowing, worse on the left. At L4-L5 there is disk bulge, and ligamentum flavum thickening resulting in moderate to severe spinal canal stenosis. There is moderate to severe left and moderate right neural foraminal stenosis. There is moderate bilateral facet arthropathy with irregularity and subchondral cystic change lateral to the pars interarticularis..At L5-S1 there is disk bulge which is partially calcified. There is moderate to severe neural foraminal stenosis, worse on the right than the left. No significant spinal canal stenosis. Moderate bilateral facet arthropathy.Paraspinous soft tissues are within normal limits. Degenerative changes are noted involving the bilateral sacroiliac joints with vacuum phenomena. Prominent phleboliths in the pelvis. | 1. Please note for the purposes of numbering, there are 5 lumbar vertebral bodies with hypoplastic ribs articulating with L1. 2. Multilevel degenerative changes with moderate to severe spinal canal stenosis suspected at the L4-L5 level and moderate to severe neural foraminal stenosis at L4-L5 on the left and bilaterally at L5-S1. These findings can be further assessed with MRI which is pending. 3. Grade 1 anterolisthesis of L4 on L5. Moderate facet arthropathy at L4-L5 and L5-S1. |
Generate impression based on findings. | Reason: 71 year old female patient diagnosed with HCC is here for administration of THERASPHERES in conjunction with a nuclear medicine study Please refer to interventional radiology study for description of procedure and images. | Successful Y90 Therasphere administration to liver tumor via the right hepatic artery. Please refer to interventional radiology exam for description of procedure and images. |
Generate impression based on findings. | Female 49 years old Reason: r/o colitis History: abd 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: Punctate right renal stone. Mild caliectasis involving the right kidney likely secondary to compression of the right ureter by the large leiomyomatous uterus, not significantly changed.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Large leiomyomatous uterus extending superiorly to the level of the liver in the abdomen and compressing the gastrointestinal tract most of the bowel segments. The uterus measures 30 x 15 cm.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 | Limited study due to lack of intravenous contrast. Significantly enlarged leiomyomatous uterus extending superiorly to the level of the liver compressing the bowel segments.Mild right caliectasis, not significantly changed from previous study. This is likely caused by compression of the right ureter by the large uterus. Punctate right renal stone. |
Generate impression based on findings. | The ventricles and sulci are increasingly prominent, consistent with progressed and now moderate age-related volume loss. There is no midline shift or mass effect. There is no intracranial hemorrhage. There are scattered punctate and confluent areas of abnormal low density in the periventricular and subcortical white matter, slightly progressed, consistent with mild chronic small vessel ischemic changes. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. There is hyperostosis frontalis interna. | No acute intracranial abnormality. Slightly progressed mild chronic small vessel ischemic changes. |
Generate impression based on findings. | There is a tiny oval hyperdense structure measuring 3 x 2 mm in greatest axial dimensions on 5/23 along the medial aspect of the left lens. Hounsfield units measure greater than 1000. The anterior chamber appears to be slightly widened as compared to the right side. There is slight disconjugate gaze with the right globe slightly more laterally rotated than the left.The extraocular muscles and optic nerves are normal in size and density. No mass is seen in the orbits within the limitations of this noncontrast exam. No bone destruction or fracture of the orbital walls is seen. There is mild mucosal thickening in the maxillary sinuses and scattered in bilateral ethmoid air cells. There is trace mucosal thickening in the right frontal sinus inferiorly. The right ostiomeatal unit is opacified. | 3 x 2 mm significantly hyperdense oval structure along the medial aspect of the left lens with questioned slight widening of the left anterior chamber. While this could represent retained metallic foreign body, as clinically suspected, the possibly of calcification is not entirely excluded. Please correlate with clinical history. |
Generate impression based on findings. | Male 56 years old Reason: ct urogram for hematuria History: hematuria ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Numerous, subcentimeter hypodense lesions throughout the liver which are too small to accurately characterize but are most likely benign.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Two punctate renal stones in the lower pole of the right kidney. A punctate stone in the upper pole of the left kidney. 4.8 cm simple cyst in the upper pole of the right kidney. Small simple cysts in the left kidney.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.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 | Bilateral punctate stones and simple cysts without evidence of hydronephrosis or solid renal lesions. |
Generate impression based on findings. | Female 82 years old Reason: rule out bowel obstruction History: nausea and vomiting, history of stage IV uterine cancer ABDOMEN:LUNG BASES: Cardiomegaly. Ectatic descending thoracic aorta measuring 4-cm in diameter.LIVER, BILIARY TRACT: Subcentimeter liver lesions, too small to accurately characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule measuring 12 x 7 mm unchanged from previous CT.KIDNEYS, URETERS: Small hypodense lesions in the kidneys which are too small to accurately characterize. A heterogeneous 7-mm hypodense lesion in the lower pole of the left kidney, best seen on image number 49, series number 5 is unchanged from previous CT dated 5/27/2014 and may represent a complex cyst or small solid lesion.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Stomach and proximal small bowel loops are significant distended. Proximal small bowel loops measure up to 4.1-cm. Distal small bowel loops are decompressed. This has progressed compared to previous study. These findings are consistent with distal small bowel obstruction with transition point likely in the left lower quadrant.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Not visualized.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small amount of ascites. Small enhancing nodularity in the pelvic peritoneum is suspicious for peritoneal implants.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Severe distal small bowel obstruction which has worsened from previous study. Possible peritoneal implants in the pelvis.Follow-up imaging is recommended for further evaluation of the left renal subcentimeter lesion in 6 months.These findings were discussed and acknowledged by Dr. Tenney at the time of dictation. |
Generate impression based on findings. | Female 71 years old Reason: hematuria work up History: hx of bilateral adrenalectomy, recent microscopic hematurai ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Status post bilateral adrenalectomy.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Significant atherosclerotic changes.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of renal stones, or solid renal lesions. |
Generate impression based on findings. | Male 62 years old Reason: Crohn's disease of large and small intestine; evaluate for stricture vs inflammation History: intermittent small bowel obstructions ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Simple left renal cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes with multiple enteroenteric anastomosis in the right lower quadrant. At the level of the terminal ileum there is mild increase wall of thickening and enhancement of the wall for a short segment followed up with a short segment of prestenotic dilatation. These findings may represent mild acute on chronic changes involving the terminal ileum causing mild stricturing.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 | CT findings compatible with mild acute on chronic changes involving a short segment of terminal ileum. Postsurgical changes involving the right lower quadrant small bowel segments. |
Generate impression based on findings. | Reason: Resolution of micronodules, Development of bronchiectasis or parenchymal opacities History: ANCA positive blood test, MAI infection, positive scleroderma antibody. S/P course of prednisone LUNGS AND PLEURA: Nonspecific apical scarring.Scattered punctate micronodules, all benign in appearance.There is no evidence of interstitial lung disease.Mild bronchial wall thickening is seen in the lung bases and in the right upper lobe.MEDIASTINUM AND HILA: Prominent residual thymic tissue.No mediastinal or hilar lymphadenopathy.No visible coronary calcifications, the heart and pericardium normal in appearance with a physiologic amount of pericardial fluid present, unchanged. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No evidence of interstitial lung disease or pulmonary manifestations of vasculitis.2. Mild bronchial wall thickening.3. Only punctate micronodules, all benign in appearance. |
Generate impression based on findings. | History: chronic sinusitis treated medically without resolution. There is extensive opacification of the bilateral maxillary sinuses with presumed retention cysts. There is partial opacification of the ethmoid sinuses. There are bubbly secretions within the left sphenoid sinus. There is minimal mucosal thickening within the right sphenoid sinus. The frontal sinuses are clear. There is mild scattered opacification of the nasal cavity. There is a pneumatized crista galli. The nasal septum is essentially midline. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. The nasopharynx, facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable. There are multiple dental caries. There appears to be lucency and cortical thinning involving the spinous process of C2. | 1. Findings suggestive of scattered sinusitis with an acute component in the left sphenoid sinus.2. Dental disease.3. Apparent lucency and cortical thinning involving the spinous process of C2, which is of indeterminate significance. An MRI may be useful for further evaluation. |
Generate impression based on findings. | T2N0 squamous cell carcinoma of the oral tongue status post partial glossectomy with neck dissection on 11/3/2014. There are postoperative findings related to right partial glossectomy with neck dissection. There is no evidence of measurable mass lesions or significant cervical lymphadenopathy based on size criteria. The salivary glands are unremarkable. There is a subcentimeter fat-attenuation right thyrolipoma. The major cervical vessels are patent. There is multilevel degenerative spondylosis of the cervical spine. There are multiple dental caries. The airways are patent. There is a patulous thoracic esophagus with layering fluid. The imaged intracranial structures are unremarkable. There are emphysematous changes in the partially-imaged lungs. | 1. Expected postoperative findings without evidence of measurable locoregional tumor or significant cervical lymphadenopathy based on size criteria. 2. A patulous thoracic esophagus may represent achalasia or scleroderma, among other possibilities.3. Dental disease. |
Generate impression based on findings. | Male 62 years old Reason: High NH3 levels, post-OLT evaluate for shunt History: confusion ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Hepatic artery, main portal vein and right and left portal vein branches are patent. No evidence of biliary dilatation or focal lesions in the liver.SPLEEN: Splenomegaly, unchanged. Portosystemic varices, again noted.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Renal cysts are unchanged. Some of these cysts are complicated and follow-up imaging in 6 months can be helpful for further evaluation.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: 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 | Patent vasculature of the liver transplant without any focal liver lesions. |
Generate impression based on findings. | Female 89 years old; Reason: AS History: Dyspnea ABDOMEN:Evaluation of solid organ parenchyma suboptimal due to arterial timing of IV contrast bolus. LUNGS BASES: Please refer to dedicated chest portion of the exam for additional findings.LIVER, BILIARY TRACT: Layering calcification and debris in gallbladder. In addition, there is adherent focal soft tissue attenuation measuring 1.5 x 0.9 cm seen along the nondependent gallbladder wall, image 204 series 5. No biliary ductal dilatation.SPLEEN: Heterogeneous attenuation of spleen, making assessment for underlying lesion suboptimal. Peripheral relatively hyperattenuating nodularity seen peripherally in posterior aspect, image 127 series 5, may be within normal limits but nonspecific.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Subcentimeter right renal hypoattenuating lesion, inadequately characterized, particularly due to small size and intraparenchymal location, image 209 series 5. Bilateral renal cortical thinning, likely reflecting chronic renal disease/areas of scarring. Left-sided extrarenal pelvis. Symmetric renal parenchymal enhancement.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Scattered colonic diverticula without evidence of acute diverticulitis. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Diffusely decreased osseous mineralization. Multilevel degenerative changes of spine. VASCULAR: Right common iliac artery measures 1.2 cm, and left common iliac artery measures 1.2 cm. Right external iliac artery measures 0.9 cm, and left external iliac artery measures 0.9 cm. Right common femoral artery measures 0.8 cm, and left common femoral artery measures 0.9 cm. Moderate to severe discontinuous circumferential abdominal aortic calcifications seen. Left greater than right mild to moderate common iliac arterial calcifications. Minimal external iliac calcifications seen. Moderate calcifications of bilateral common femoral arteries, involving approximately 50% of vessel circumference. Patent celiac and superior mesenteric artery origins. Patent bilateral renal arteries. Nonaneurysmal abdominal aorta. Aneurysmal dilatation of bilateral internal iliac arteries, measuring up to 1.2 cm (on left side). | 1. Gallbladder intraluminal soft tissue focus, underlying neoplasm not entirely excluded, adherent sludge another differential consideration. Further evaluation with dedicated ultrasound imaging or dedicated CT or MRI without and with contrast recommended for further characterization.2. Atherosclerotic disease and aortobiiliac measurements as above.3. Please refer to CT chest portion of exam for additional findings. |
Generate impression based on findings. | There is persistent asymmetric hypoattenuation in the right posterior frontal, parietal, occipital lobes as well as the left parietal lobe which is similar to the prior examination. There is no acute intracranial hemorrhage or midline shift. The ventricles and sulci are unchanged. There is no hydrocephalus. There is no herniation. There is mild atherosclerotic calcification in the bilateral C4 vertebral artery segments and cavernous internal carotid arteries. There are mucus retention cysts in bilateral maxillary sinuses. A nasogastric tube is partly imaged and there are scattered bilateral mastoid opacification. There is mild left maxillary sinus and scattered ethmoid sinus mucosal thickening. The calvarium is intact. | 1.No acute intracranial hemorrhage or midline shift. 2.Persistent multifocal areas of parenchymal low attenuation, similar to the prior exam. Although these abnormal areas of low attenuation could represent subacute infarcts, there is no clear interval evolution from 2/12/2015. Additional differential diagnosis includes infectious etiologies and infiltrative neoplastic etiologies also be considered in the appropriate clinical setting. 3.If there are no contraindications, further evaluation with MRI brain without and with IV contrast is recommended for further evaluation. |
Generate impression based on findings. | Frequent sinusitis, treated with antibiotics. There are postoperative findings related to endoscopic sinus surgery. There is a punctate left maxillary sinus rentention cyst. The other paranasal sinuses are clear and the neo-infundibula are patent. There are minimal secretions within the nasal cavity. The nasal septum is essentially midline. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. The nasopharynx, facial soft tissues, orbits, and imaged intracranial structures appear to be unremarkable. There is an incomplete posterior arch of C1, which is an anatomic variant. | Postoperative findings related to endoscopic sinus surgery with a punctate left maxillary sinus rentention cyst, but no evidence of acute sinusitis. |
Generate impression based on findings. | Right heart failure of unknown etiology. The comparison chest radiograph performed on 2/15/2015 demonstrates stable cardiomegaly but no focal pulmonary opacities or pleural fluid. The ventilation images show a uniform distribution of activity on single-breath and wash-in images. There is no abnormal Xe-133 retention during the wash-out phase. The perfusion images show a possible small mismatched defect in the right upper lobe. Otherwise there are no significant defects. | Low probability scan for a pulmonary embolism. |
Generate impression based on findings. | Male 28 years old; Reason: Evaluate for hydrocele vs incarcerated inguinal hernia History: testicular swelling RIGHT TESTIS: Measures 5.2 x 3 x 2.5 cm. No focal parenchymal lesion. Symmetric normal testicular parenchymal vascularity.LEFT TESTIS: Measures 5.1 by 3 x 2.5 cm. No focal parenchymal lesion. Symmetric normal testicular parenchymal vascularity.RIGHT EPIDIDYMIS: Unremarkable.LEFT EPIDIDYMIS: Unremarkable.OTHER: Small bilateral hydroceles and varicoceles. Left inguinal area interrogated to evaluate for inguinal hernia, no hernia delineated. | 1. Small bilateral hydroceles and varicoceles. |
Generate impression based on findings. | Relapsed Burkitt lymphoma. Status post 4 cycles of chemo.RADIOPHARMACEUTICAL: 10.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 127 mg/dL. CT: demonstrates a right sided porta cath in the right atrium, tumor infiltration of the peri-rectal fat, scattered osseous sclerotic calcifications and trace pericardial effusion. Today's PET examination demonstrates essentially complete resolution of abnormal activity previously seen in the head and neck as well as the previous abdominal and pelvic soft tissue tumor sites.There is however, new suspicious hypermetabolic activity most notably in the left perirectal fat where a new markedly metabolic region with an SUVmax of 6.2 corresponds with new soft tissue infiltration of perirectal fat and perirectal thickening on CT. This is very suspicious for progression of tumor in this location. Additional new smaller hypermetabolic foci in the peri-rectal tissues likely represents additional new tumor.In addition, there are several hypermetabolic intra-muscular foci medial to the right iliac wing suspicious for new tumor and then a new markedly hypermetabolic focus is seen along region of thickened right colon with an SUVmax of 10.1, which is suspicious for additional tumor.The previous scan demonstrated tumor activity in the right femur. The current study demonstrates diffuse benign marrow likely from GCS stimulation. Therefore current osseous tumor involvement cannot be determined. | Probable mixed interval response. While there has essentially been complete resolution of previous extensive soft tissue tumor activity, there are multiple findings suspicious for progression at other soft tissue sites within the abdomen and pelvis. |
Generate impression based on findings. | 88 years, Male. Reason: rising WBC, concern for constipation or infection History: as above IVC filter is again noted. Partially visualized screws noted in the left femoral head. Right internal jugular central venous catheter tip at the superior cavoatrial junction. Nonobstructive bowel gas pattern. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 76-year-old female patient with recurrent GI bleeding. Evaluate for small bowel mass or stricture. Scout radiograph showed a nonobstructive bowel gas pattern. Transit time to the colon was 30 minutes. Fluoroscopic evaluation showed normal mucosa throughout the majority of the small bowel, with no ulcers, sinus tracts, fistulae, or adhesions. No separation of bowel loops was present to suggest fibrofatty proliferation. There were 3 discrete diverticula in the terminal ileum (series 6). The ileocecal valve were normal in appearance. No internal hernias or ventral hernias were evident. There is extensive diverticulosis and stool in the visualized descending and transverse colon.TOTAL FLUOROSCOPY TIME: 6:17 minutes | Terminal ileum and colonic diverticulosis. Specifically, no small bowel masses or strictures were seen. |
Generate impression based on findings. | 15-year-old female, evaluate for new opacificationVIEW: Chest AP (one view) 2/19/15 11:14 ETT below the thoracic inlet. Right PICC tip unchanged in position. Unchanged spinal hardware. The cardiothymic silhouette is normal.Right pleural effusion and basilar atelectasis and opacity appear similar to the prior exam. | Right pleural effusion and basilar opacity appearing similar to the prior exam. |
Generate impression based on findings. | Reason: AATD, cough, sputum, r/o bronchiectasis History: cough, sob LUNGS AND PLEURA: Moderate apical predominant panacinar emphysema. No evidence of bronchiectasis.No suspicious pulmonary nodules or masses.Moderate basilar subsegmental atelectasis/scarring.Trace right pleural effusion with minimal associated atelectasis.MEDIASTINUM AND HILA: The heart is normal in size with trace pericardial effusion/thickening. No visible coronary artery cusp.No mediastinal or hilar lymphadenopathy. TheCHEST WALL: Bilateral breast prostheses.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Subcentimeter right renal hypodensity is partially visualized, measuring near water density, likely a benign cyst. | Moderate panacinar emphysema in a patient with known alpha-1 antitrypsin deficiency. No evidence of bronchiectasis or infection. |
Generate impression based on findings. | Ms. Cho is a 48 year old female with a personal history of right breast mastectomy 2007 for cancer. She has no current breast related complaints. Three standard views of the left 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. Few scattered benign calcifications are seen. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the left breast. | 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. | Asymptomatic female presents for routine screening mammography. Mother and sister with history of breast cancer. 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, 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. | 9-year-old male status post line placementVIEW: Chest AP (one view) 2/19/13 12:35 ETT tip below the thoracic inlet. NG tube is doubled back on itself with its tip in the mid thoracic esophagus. Right pleural drain is unchanged in position. Interval placement of right chest tube with its tip along the lateral chest wall. The cardiothymic silhouette is upper limits of normal.Moderate right pleural effusion and adjacent atelectasis is not significantly change. No pneumothorax is visualized. | Interval placement of right chest tube with tip along the lateral chest wall. Unchanged pleural effusion. NG tube coiled back on itself with its tip in the midthoracic esophagus. |
Generate impression based on findings. | 85-year-old female with dysphagia. EPIC history: recent EGD showed a hiatal hernia and esophagitis in the distal esophagus, and a large bulge in lower esophagus suggestive of extrinsic compression. CHEST:LUNGS AND PLEURA: Significant motion in the bases limits evaluation.Numerous pulmonary nodules diffusely, greater in the mid to lower zones bilaterally, range in size from micronodules to the largest nodule that is subpleural in the right lower lobe measuring 19 x 28 mm (series 8, image 64). No pleural effusion. Mild mosaic attenuation of the lungs may relate to small airways disease or small vessel disease.Left basilar periaortic subsegmental atelectasis.MEDIASTINUM AND HILA: Enlarged subcarinal lymph node measuring 11 mm.Dilated main pulmonary artery to 3.6 cm consistent with pulmonary artery hypertension.Mild coronary artery calcification. Mild cardiomegaly without pericardial effusion.Small hiatal hernia. Mildly patulous upper thoracic esophagus with debris. No obvious esophageal mass or extrinsically compressing lesion is identified.CHEST WALL: Mild degenerative changes of the thoracolumbar spine. Nonspecific 8 mm right upper chest wall subcutaneous nodule (series 6, image 14), which may be a sebaceous cyst or a metastasis.ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis. SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Presumed small left adrenal adenoma.KIDNEYS, URETERS: Post-surgical findings of left nephrectomy. Right renal cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Left periaortic retroperitoneal surgical clips. No retroperitoneal lymphadenopathy.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. | 1. Multiple bilateral pulmonary nodules of varying sizes, of a distribution and size, suspicious for metastases. Comparison to prior studies, particularly CT exams, would be helpful to evaluate for interval growth or stability of these nodules. 2. Enlarged subcarinal lymph node. Right anterior chest wall nonspecific subcutaneous nodule, which may be a sebaceous cyst or a metastasis.3. No discrete extrinsically compressing esophageal lesion is identified. |
Generate impression based on findings. | 8-day-old male with RDS.VIEW: Chest AP (one view) 2/19/2015 1134 ET tube tip at thoracic inlet. Feeding tube tip at the GE junction with sidehole in distal esophagus. Umbilical arterial catheter tip at level of T8. Normal cardiothymic silhouette. Diffuse bilateral atelectasis is not significantly changed. No pleural effusion or pneumothorax. | 1.No significant interval change in diffuse bilateral atelectasis, compatible with RDS.2.Feeding tube tip at the GE junction with sidehole in distal esophagus. |
Generate impression based on findings. | Male 35 years old Reason: r/o dissection History: HTN CT Angiography: There is no evidence of aortic aneurysm, dissection, or significant stenosis. The origins of the great vessels, celiac axis, SMA, and renal arteries are patent. No evidence of atherosclerotic disease. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: There is concentric left ventricular hypertrophy without pericardial effusion. Pulmonary artery is enlarged and measures up to 33 mm which is suggestive of pulmonary arterial hypertension.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Concentric left ventricular hypertrophy.2. Enlarged pulmonary artery which is suggestive of pulmonary arterial hypertension.3. There is no evidence of aortic aneurysm, dissection, or significant stenosis. |
Generate impression based on findings. | Mediastinal adenopathy, balance/coordination problems. Question of tumor or sarcoid. RADIOPHARMACEUTICAL: 9.9 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 93 mg/dL. Today's CT portion grossly demonstrates enlarged paratracheal and bilateral hilar lymph nodes. There are also several mildly enlarged bilateral iliac lymph nodes in the pelvis. Today's PET examination demonstrates:Neck: There are bilateral small but markedly hypermetabolic supraclavicular lymph nodes (max SUV = 11.0). There is also a markedly hypermetabolic medium sized focus involving the proximal esophagus (max SUV = 16.1).Chest: There are extensive fairly symmetric markedly hypermetabolic bilateral hilar and mediastinal lymph nodes, involving the paratracheal, prevascular, subcarinal, and paraaortic stations (max SUV = 19.5). A crescentic focus of activity within the wall of the distal thoracic aorta is consistent with inflammation, likely early atherosclerotic disease. Abdomen: A single small but significantly hypermetabolic peri-pancreatic lymph node (max SUV = 7.2) is identified. Pelvis: There are numerous small but markedly hypermetabolic but fairly symmetric lymph nodes involving the bilateral common iliac, external iliac, and obturator stations (max SUV = 9.6). | 1.Widespread fairly symmetric markedly hypermetabolic lymph nodes most notably in the chest and pelvis with more modest involvement of the neck and abdomen. Given the distribution, sarcoid is a likely etiology. Tumor such as lymphoma is another consideration.2.Markedly hypermetabolic proximal esophageal focus; this could represent unusually prominent physiologic upper esophageal sphincter activity. However, esophageal cancer cannot be entirely excluded. Please correlate clinically for associated symptoms, such as dysphagia, as for the need for further evaluation such as with endoscopy. |
Generate impression based on findings. | 58 years, Male. Reason: OGT placement, intubated with aspiration PNA and e/o esophageal dysmotility History: as above Enteric feeding tube tip projects over the distal gastric body. Nonobstructive bowel gas pattern. Bilateral pleural effusions.The lower portion of the pelvis is excluded from the field-of-view. | Enteric feeding tube tip projects over the distal gastric body. |
Generate impression based on findings. | Female 46 years old Reason: r/o toe fx to 3rd and 4th toes History: stubbed left foot. There is mild soft tissue swelling about and fourth toes. There is a minimally displaced oblique fracture of the proximal phalanx of the third toe. The bones of the fourth toes appear unremarkable without an evident fracture. | Fracture of the third proximal phalanx. |
Generate impression based on findings. | Reason: Large laryngeal mass, assess for lung disease History: same LUNGS AND PLEURA: Mild to moderate paraseptal emphysema.No suspicious pulmonary nodules or masses.Moderate dependent atelectasis, may relate to aspiration. No other focal areas of consolidation.No pleural effusion.Moderate pneumomediastinum with extension laterally into the extrapleural space. No pneumothorax.MEDIASTINUM AND HILA: Moderate pneumomediastinum and soft tissue emphysema in the anterior chest wall and neck, likely related to recent emergent tracheostomy placement.Heterogeneous soft tissue mass in the neck is partially visualized on this exam. See same day CT soft tissue neck for additional details.Tracheostomy tube in place. Dobbhoff tube terminates in the stomach.The heart is mildly enlarged, without pericardial effusion. Moderate coronary artery calcification. The main pulmonary artery is enlarged, suggesting pulmonary hypertension.The ascending aorta is ectatic, measuring up to 4.5 cm.No mediastinal or hilar lymphadenopathy.CHEST WALL: Soft tissue emphysema in the anterior chest wall likely related to recent emergent tracheostomy placement.No axillary lymphadenopathy.Multiple sclerotic foci of varying sizes throughout the vertebral bodies, ribs, sternum, and scapulae.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Renal hypodensities, likely benign cysts. | 1. Moderate pneumomediastinum and soft tissue emphysema in the anterior chest wall and neck, likely related to recent emergent tracheostomy placement.2. Multiple sclerotic foci of varying sizes throughout the visualized skeleton, which are suspicious for osseous metastases. This particular pattern is seen most commonly in prostatic carcinoma.3. No evidence of pulmonary metastases. |
Generate impression based on findings. | 26 day old male status post mandibular distraction osteotomy.VIEWS: Mandible AP, right lateral, left lateral (3 views) 2/19/2015 at 1145 Postsurgical changes status post bilateral mandibular distraction are identified. As per discussion with the clinical service, multiple layering plates noted within the left mandibular hardware on the AP view represent normal postoperative appearance. No evidence of hardware complication. | Expected postsurgical changes status post mandibular distraction osteotomy as described above. |
Generate impression based on findings. | 15-year-old female with backache and pain along thoracic spine.VIEWS: Lumbar spine AP, lateral, L5/S1 spot view (3 views) and thoracic spine AP, lateral, Swimmers (3 views), 2/19/2015 at 1241 Thoracic Spine: No acute fracture or malalignment. Vertebral body heights preserved. No acute abnormality identified in the visualized chest.Lumbar Spine: No acute fracture or malalignment. Vertebral body heights preserved. Nonobstructive bowel gas pattern. | Normal thoracic and lumbar spinal radiographs. |
Generate impression based on findings. | Evaluate ET tubeVIEW: Chest AP ET tube tip at the level of the thoracic inlet. Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. Patchy atelectasis right lower lobe and left lower lobe. No pleural effusion or pneumothorax. | ET tube tip at the level of the thoracic inlet. |
Generate impression based on findings. | 16-year-old male with L4 fracture status post gunshot woundVIEWS: Lumbar spine, AP and lateral (two views) 2/19/15 Deformity of the L4 vertebral body consistent with fracture from gunshot wound. A bullet fragment is located just anterior to the L4 vertebral body. A fracture of the right iliac crest is partially visualized.Contrast noted in the colon from prior CT. Air fluid levels noted in the small bowel, which may represent ileus | 1. Bullet fragment adjacent to the fractured L4 vertebral body. Right iliac crest fracture is also noted.2. Dilated small bowel with air-fluid levels, likely representing ileus. |
Generate impression based on findings. | Ms. Hetfield is a 67 year old female with a personal history of right breast lumpectomy 2001 for cancer followed by radiation and tamoxifen therapy. She also had left mammoplasty surgery. She has no current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the right breast. There are stable postsurgical changes including architectural distortion and increased density present within the right lumpectomy site. Scattered benign calcifications and stable asymmetries are present bilaterally. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | Stable postsurgical changes. 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. | HCC. Concern for metastatic disease. No abnormal osseous foci are identified to indicate metastatic disease. | No evidence of bone metastases. |
Generate impression based on findings. | Chest tube and NG placementVIEW: Chest AP ET tube tip below thoracic inlet and above the carina. NG tube tip at the GE junction. Left upper extremity PICC with tip in the right atrium. Right pigtail catheter again noted. Right chest tube with tip at the right apex. Cardiothymic silhouette normal. Patchy atelectasis bilaterally with small bilateral pleural effusions not significantly changed. | NG tube tip at the GE junction and right chest tube tip at the right apex. |
Generate impression based on findings. | 40 year-old female with history of Hodgkin lymphoma. CHEST:LUNGS AND PLEURA: Right middle lobe nodule (series 5, image 75) measures 7 x 8 mm, previously 8 x 8 mm. Scattered nonspecific pulmonary micronodules, unchanged. No focal pulmonary opacities or pleural effusions.MEDIASTINUM AND HILA: Redemonstration of mediastinal and hilar lymphadenopathy, stable to slightly decreased. As a reference, a precarinal lymph node measures 0.9 x 1.4 cm (series 701, image 36), previously 1.0 x 1.5 cm. CHEST WALL: Right chest wall Port-A-Cath with the tip terminating in the right atrium. Reference left axillary lymph node measures 0.8 x 1.0 cm (series 701, image 42), previously 1.0 x 1.0 cm.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonobstructive subcentimeter right renal stone.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No suspicious osseous lesions.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Enlarged leiomyomatous uterus without significant interval change. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No suspicious osseous lesions.OTHER: No significant abnormality noted. | 1.Reference mediastinal and axillary lymph nodes stable to slightly decreased. No new lymphadenopathy. 2.Stable right middle lobe pulmonary nodule. |
Generate impression based on findings. | Ms. Smith is a 61 year old female with a personal history of benign right breast biopsy in September 2013 for an intraductal papilloma. Family history of breast cancer in sister diagnosed at the age of 31. 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. Ribbon clip is identified in the right retroareolar region, at site of prior benign breast biopsy. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. Benign intramammary lymph node identified in the right upper outer breast. An AICD device obscures the left axilla. | Benign intramammary lymph node 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. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Male 80 years old Reason: pain History: pain Severe osteoarthritis affects the right knee with bone on bone apposition in the medial compartment and tricompartmental osteophytes. There is a small joint effusion. No acute fracture or malalignment.Moderate osteoarthritis affects the left knee with moderate medial compartment joint space narrowing and tricompartmental osteophytes. Benign-appearing sclerotic foci in the left proximal tibia is unchanged. | Severe right knee and moderate left knee osteoarthritis. |
Generate impression based on findings. | Male 66 years old Reason: osteoarthritis History: h/o left knee osteoarthritis Bone mineralization is normal. Alignment is near-anatomic. Moderate joint space filling in the medial compartment. There are small osteophytes. There is a small joint effusion. No acute fracture or malalignment | Mild to moderate left knee osteoarthritis. |
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