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Generate impression based on findings. | Female 33 years old Reason: RLQ pain, hx of hernia, (R) ovarian cyst ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver. Mild hepatomegaly.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: Large midline incisional hernia containing fat and nonobstructed small bowel segments. There is a second hernia more inferiorly in the midline slightly toward the left in the pelvis. This hernia also contains nonobstructed small bowel segments and mesenteric fat.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: 4.4 x 4.3 cm cystic mass arising from the right ovary. Another focal lesion the right ovary measures 3 x 2.2 cm. Left ovary and uterus are unremarkable. Right adnexal mass cannot be optimally characterized with the CT. Further evaluation with transvaginal ultrasound and/or pelvic MRI is recommended. A cystic neoplasm cannot be excluded.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 | Right adnexal mass cannot be optimally characterized with the CT. Further evaluation with transvaginal ultrasound and/or pelvic MRI is recommended. A cystic ovarian neoplasm cannot be excluded.Multiple midline. Incisional hernias containing fat and nonobstructed small bowel segments.Diffuse fatty infiltration of the liver. |
Generate impression based on findings. | Male 28 years old Reason: rule out indirect inguinal hernia History: scrotal pain The study is limited due to lack of intravenous contrast.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Multiple hypodense lesions in the liver cannot be optimally characterized with this noncontrast CT. largest lesion measures 2.2 cm in the right lobe of the liver.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: 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: There is a large left inguinal hernia containing fat. There is no evidence of bowel within the hernia content. The density of the fat within the inguinal canal is slightly increased. Ischemia of the fat cannot be excluded. | Large left inguinal fat containing hernia. Strangulation of the hernia cannot be excluded.Multiple hypodense lesions in the liver cannot be optimally characterized with this noncontrast CT. Further evaluation with liver MRI may be helpful, if clinically indicated. |
Generate impression based on findings. | Female 34 years old Reason: Signs of abscess History: abdominal pain s/p c-section ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal benign appearing lesion measuring 2-cm in diameter image number 38, series number 3. Right adrenal gland is unremarkable.KIDNEYS, 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:UTERUS, ADNEXA: Uterus is enlarged compatible with the recent C-section. Endovaginal stripe is slightly dilated measuring up to 1.3-cm. Endometrial content is heterogeneous.BLADDER: No significant abnormality notedLYMPH NODES: Bilateral inguinal and pelvic adenopathy of uncertain etiology and significance. An index right inguinal node measures 2.2 by 1.5-cm image number 149, series number 3.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Postsurgical changes involving the anterior abdominal wall. There is a small collection in the subcutaneous tissues of the right lower quadrant pelvis anterior to the right rectus muscle measuring 2.6 x 1.6 cm image number 119, series number 3. Significant fat stranding involving the subcutaneous fat of the pelvis.OTHER: No significant abnormality noted | Extensive postsurgical changes involving the pelvic anterior abdominal wall with a small subcutaneous collection.Enlarged uterus compatible with recent C-section. Images tract is minimally dilated. Correlation with pelvic ultrasound findings is recommended to exclude retained products of conception.Benign appearing left adrenal lesion. |
Generate impression based on findings. | Female 49 years old Reason: ro SBO, pancreatic pseudocyst History: epigastric pain, mult abd surgeries, decreased ostomy output ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Again noted diffuse dilatation of the main pancreatic duct up to the level of the pancreatic head. Is mild interval enlargement of the pancreatic head associated with peripancreatic fat stranding. These findings are likely compatible with acute on chronic focal pancreatitis involving the pancreatic head. No evidence of pseudocyst. Again noted calcifications within the pancreatic head.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Left lower quadrant ostomy. No evidence of bowel obstruction.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 | Focal acute pancreatitis involving the pancreatic head in the background of chronic pancreatitis.These findings were discussed and acknowledged by Dr. Lindsey at the time of dictation. |
Generate impression based on findings. | Reason: shock History: shock, abdominal pain, tachycardia The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | No evidence for acute intracranial hemorrhage mass effect or edema. |
Generate impression based on findings. | Evaluate status-post left total hip arthroplasty The AP view of the left hip shows components of a total hip arthroplasty device situated in near-anatomic alignment without radiographic evidence of complication. A drain and foci of gas density in the soft tissues reflect recent surgery. Surgical clips are noted within the medial thigh.The AP view of the pelvis reveals the aforementioned postoperative changes on the left. Mild osteoarthritis affects the right hip. Mild degenerative arthritis also affects the pubic symphysis and sacroiliac joints. Severe degenerative disk disease affects the visualized lower lumbar spine. | Total hip arthroplasty as above. |
Generate impression based on findings. | Reason: eval ICH History: fall A focus of encephalomalacia is present in the right frontal lobe.Periventricular and subcortical white matter hypodensities of a moderate degree are present. Hypodensities are also redemonstrated in the root of the thalami , basal ganglia, internal capsules, the left cerebral peduncle and pons.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.A focus of encephalomalacia in the right frontal lobe is redemonstrated and most likely vascular related.3.Lesions in the brainstem, thalami , basal ganglia and internal capsules are likely vascular related.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 5.CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction. |
Generate impression based on findings. | 57-year-old male paraplegic with upper extremity contractures and chronic right shoulder pain (never imaged), rule out fracture or underlying pathology. The bones appear demineralized, presumably due to disuse. I see no fracture or gross malalignment. Chronic appearing bone formation along the inferior aspect of the scapular neck appears similar to that seen on the prior study and is of doubtful current clinical significance. Mild chronic-appearing rib deformities may represent old fractures. Mild degenerative arthritic changes affect the spine. | Demineralized bones and other findings as above. I see no fracture or other specific findings to account for the patient's pain. |
Generate impression based on findings. | Examination is slightly motion degraded. Dedicated images through the sella demonstrate a normal height of the pituitary gland. There is redemonstration of a nonenhancing lesion in the left posterior aspect of the pituitary measuring 5 x 7 mm (AP x CC), previously 5 x 8 mm. The pituitary stalk lies in the midline. Suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable.The partially imaged intracranial structures are unremarkable. | Compared to 1/30/2008, unchanged size and appearance of subcentimeter nonenhancing lesion in the left posterior sella which may represent a pituitary microadenoma. |
Generate impression based on findings. | The sulci are prominent with slight interval increase in size of the ventricles compared to 2012, which may represent progression of volume loss. A component of hydrocephalus cannot be excluded. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. There are small areas of old cortical/subcortical infarcts including the right superior frontal gyrus and right paracentral lobule and left inferior temporal gyrus. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening of the left maxillary sinus. | 1. No acute infarct. Multiple small chronic infarcts as above similar to prior.2. Compared to MRI 11/14/2012, there is slight interval increase in size of the ventricles which are prominent and likely related to moderate global parenchymal volume loss. A component of communicating hydrocephalus/NPH cannot be entirely excluded and can be correlated with clinical findings. |
Generate impression based on findings. | No structural lesions are appreciated. There is no diffusion abnormality. The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There are no areas of abnormal signal. No extra-axial fluid collection is identified. Sulcation and myelination is appropriate for patient's corrected age with myelination noted in the posterior limbs of the internal capsules. Midline structures and posterior fossa appear within normal limits. Normal flow-voids are demonstrated in the major intracranial vascular structures. | Examination is within normal limits for age. No structural lesions are appreciated. No residual hemorrhage or hydrocephalus. |
Generate impression based on findings. | The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. There are no extraaxial fluid collections or subdural hematomas. Note is made of presumed postsurgical changes throughout nasal sinuses including significant opacification throughout a majority of the residual paranasal sinuses. The mastoid air cells are clear. | No CT evidence of acute intracranial process. If there is continued clinical concern for acute ischemia, MRI would be recommended. |
Generate impression based on findings. | There is no intracranial hemorrhage. There is no midline shift or mass effect. The ventricles and sulci are prominent, consistent with mild age-related volume loss, relatively greater involving the bilateral frontoparietal lobes. There are scattered punctate and confluent areas of abnormal low density in the periventricular and subcortical white matter, consistent with mild age-indeterminate 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 debris in the bilateral external auditory canals, likely representing cerumen. There are bilateral lens implants. | No acute intracranial hemorrhage or mass effect. If there is continued suspicion for an intracranial structural lesion, MRI of the brain should be considered. |
Generate impression based on findings. | 65 years, Female. Reason: NG tube placement History: NG tube placement Enteric feeding tube tip projects over the gastric body and sidehole projects over the gastroesophageal junction. Nonobstructive bowel gas pattern. Body wall laxity on the right may represent body wall hernia. | Enteric feeding tube tip projects over the gastric body and sidehole projects over the gastroesophageal junction. |
Generate impression based on findings. | Status post left reversed total shoulder arthroplasty Evaluation of fine detail is limited by overlying artifact on the patient's skin. Components of a "reverse" left total shoulder arthroplasty device are situated in near-anatomic alignment without radiographic evidence of hardware complication. Drains and foci of gas density within the soft tissues reflect recent surgery. A catheter overlies the base of the neck. Degenerative arthritic changes affect the spine. The left lung is underinflated. | Postoperative changes of reverse total shoulder arthroplasty as above. |
Generate impression based on findings. | 57 years, Male. Reason: eval for stool burden; w/ pancreatic ca s/p duodenal stent History: constipation Duodenal stent is in place. Spinal fixation hardware traversing L3-S1 with disc spacers is noted. Nonobstructive bowel gas pattern. Average stool burden. Gallstone in the right upper quadrant. Calcified stone in the left lower quadrant, also seen on recent CT. | Average stool burden. Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Reason: eval ICH vs met History: SCLC, p/w AMS The CSF spaces are appropriate for the patient's stated age with no midline shift. A hypodense focus is redemonstrated in the left centrum semiovaleNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Atherosclerotic calcifications are present along the distal internal carotid arteries.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.A small lesion in the left centrum semiovale probably represents an old lacunar infarct |
Generate impression based on findings. | Posterior fossa structures are degraded secondary to streak artifact. Given this caveat:The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. There are no extraaxial fluid collections or subdural hematomas. Soft tissue prominence and asymmetry with left sided fat stranding is noted. Endotracheal tube and enteric tube are partially imaged. Diffuse paranasal sinus opacification with air-fluid levels is noted, presumably secondary to patient's intubated status. The mastoid air cells are clear. | Posterior fossa structures are degraded secondary to streak artifact. Given this caveat, no CT evidence for acute intracranial process to explain the patient's symptoms. |
Generate impression based on findings. | 82 years, Female. Reason: NGT in place, confirm placement History: SBO Enteric feeding tube tip projects over the gastric body and sidehole projects over the gastroesophageal junction. Enteric contrast has reached the cecum, indicating slow transit. Bibasilar atelectasis and right-sided chest port noted. Bullet fragment and surgical clips noted projecting over the right hemiabdomen.The pelvis is excluded from the field-of-view. | Enteric feeding tube tip projects over the gastric body and sidehole projects over the gastroesophageal junction. |
Generate impression based on findings. | Evaluate status post left total hip arthroplasty The AP view of the left hip shows components of a left total hip arthroplasty device situated in near-anatomic alignment without radiographic evidence of complication. A drain and foci of gas density in the soft tissues reflect recent surgery.The AP view of the pelvis reveals the aforementioned postoperative changes on the left. Severe osteoarthritis affects the right hip. Severe degenerative disk disease affects the visualized lower lumbar spine. | Postoperative changes of left total hip arthroplasty as above. |
Generate impression based on findings. | 66 years, Male. Reason: DHT placement History: DHT placed Dobbhoff tube tip projects over the gastric antrum. Mitral valve prosthesis is in place. Ileus type bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | Dobbhoff tube tip projects over the gastric antrum. |
Generate impression based on findings. | Check setting of shunt Postoperative changes of the skull have been previously described and appear similar to those seen on the prior study. Again noted is an intracranial shunt which on this single view appears similar to that seen on the prior study as well. The notch on the pressure valve points posteriorly, measuring between 130 and 140 mm of water, appearing similar to the prior study. | Shunt setting as above. |
Generate impression based on findings. | There has been interval placement of a right parietal approach ventricular catheter with its tip terminating at the midline, adjacent to the body of the lateral ventricles. The ventricular system is significantly decompressed compared to prior studies.There are new bilateral subdural fluid collections, left much greater than right, which measure 15-20 Hounsfield units in attenuation without evidence of superimposed acute hemorrhage. The left collection measures up to 3.6 cm in depth, and the right collection 9 mm. The left sided collection exerts significant mass effect on underlying parenchyma, compressing it and displacing it rightward, with a very small portion crossing midline. The right-sided collection causes mild underlying gyral flattening without significant mass effect. There is no herniation. Basilar cisterns are maintained.Mastoid air cells and middle ear cavities are clear. | 1.There has been interval placement of a right parietal approach ventricular catheter with its tip terminating at the midline. The ventricular system is significantly decompressed compared to prior studies.2.There are new bilateral subdural fluid collections, left much greater than right, which measure 15-20 Hounsfield units in attenuation without evidence of superimposed acute hemorrhage. The left collection measures up to 3.6 cm in depth, and the right collection 9 mm. The left sided collection exerts significant mass effect on underlying parenchyma, compressing it and displacing it rightward, with a very small portion crossing midline. The right-sided collection causes mild underlying gyral flattening without significant mass effect. This appearance is most suggestive of resolving subdural hematomas without an acute hemorrhagic component. |
Generate impression based on findings. | 58 years, Male. Reason: 58yoM h/o acute on chronic pancreatitis, abdominal distention worsening r/o abd free air History: worsening abdominal distention No pneumoperitoneum. Gasless abdomen. Enteric feeding tube is looped over the stomach with tip projecting over the distal gastric body.Small left pleural effusion. | Gasless abdomen without pneumoperitoneum. |
Generate impression based on findings. | 57 years, Female. Reason: DHT placement History: - Dobbhoff tube is coiled in the stomach with tip projecting over the gastric fundus. Spinal fixation hardware is noted traversing L4-S1. Cholecystectomy clips are noted in the right quadrant. Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | Dobbhoff tube is coiled in the stomach with tip projecting over the gastric fundus. |
Generate impression based on findings. | Female, 22 years old. Horizontal line of skin staples project over the lower pelvis. No unexpected radiopaque foreign objects. Nonobstructive bowel gas pattern. Epidural catheter noted. | No unexpected radiopaque foreign object.Findings discussed via telephone with Dr. Nunes at 0620 on 2/20/2015 by Dr. Bonham. |
Generate impression based on findings. | 65 years, Male. Reason: DHT Placement History: DHT Placement Dobbhoff tube tip projects over the distal gastric body. Multiple surgical clips and 8 mm radiodensity, probable bullet/pellet, are again noted. Nonobstructive bowel gas pattern. | Dobbhoff tube tip projects over the distal gastric body. |
Generate impression based on findings. | 40 years, Female. Reason: NJ placement History: NJ tip Enteric feeding tube tip is past the ligament of Treitz in the left lower quadrant. Residual enteric contrast noted in colon and rectum. Nonobstructive bowel gas pattern. | Enteric feeding tube tip is past the ligament of Treitz in the left lower quadrant. |
Generate impression based on findings. | Foot and ankle pain. Fracture or abnormality? Two views of the right ankle are provided. I see no fracture or malalignment. There is mild spurring along the medial aspect of the medial malleolus, of questionable significance. There is an enthesophyte at the Achilles insertion on the calcaneus, as well as a small plantar calcaneal spur which likely may not be of any current clinical significance.Three views of the right foot are provided. I see no fracture. Minimal osteoarthritis affects the first metatarsophalangeal joint. | Minimal degenerative changes as above; I see no fracture. |
Generate impression based on findings. | 42 years, Female. Reason: Dobbhoff placement History: Dobbhoff placement Dobbhoff tube projects over the gastric body. Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. Left basilar opacity. | Dobbhoff tube projects over the gastric body. |
Generate impression based on findings. | 69 year old female status post ERCP concerning for tumor, rule out acute abnormalities. ABDOMEN:LUNG BASES: Moderate coronary artery calcifications. Mitral valve calcifications. LIVER, BILIARY TRACT: No definite focal hepatic lesions. Cholelithiasis and mild nonspecific gallbladder wall thickening appearing similar to prior. The common bile duct is again dilated up to 1.5 cm (series 3, image 52) with common bile duct stent distal tip in duodenum. Expected pneumobilia. SPLEEN: No significant abnormality notedPANCREAS: No definite pancreatic lesion. The pancreatic duct is dilated measuring up to 8 mm presumably due to obstruction in the CBD.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Non-obstructive left renal calculus.RETROPERITONEUM, LYMPH NODES: Mesenteric cystic masses are again seen which likely represent necrotic gastrohepatic and peripancreatic lymph nodes. The largest mass (series 3, image 55) measures 3.5 x 6.6 cm. There is encasement of the celiac axis (including the hepatic artery) and SMA (including the first jejunal branch) without involvement of the portal vein or SMV.Moderate atherosclerotic calcifications affect the abdominal aorta and its branches.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: Bilateral nonspecific enlarged obturator lymph nodes. For example, right obturator lymph node (series 3, image 122) measures 1.2 x 2.3 cm. BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Dilation of the common bile duct and pancreatic duct presumably related to mass in the region of the ampulla of Vater, similar to prior. Common bile duct stent in place.2.Mesenteric cystic masses likely representing necrotic upper abdominal lymph nodes, differential diagnosis includes metastatic disease or lymphoma. 3.No specific evidence of acute complication from ERCP.4.Cholelithiasis.5.Bilateral nonspecific enlarged obturator lymph nodes. |
Generate impression based on findings. | 46 year old female with history of lymphoma. Within the limits of a non IV contrast enhanced examination which limits the ability to evaluate solid parenchymal organs and vascular structures, the following observations can be made: CHEST:LUNGS AND PLEURA: A small left pleural effusion is present. Hypermetabolic left inferoposterior pleural nodules seen on recent PET are poorly visualized.MEDIASTINUM AND HILA: Right-sided chest port with catheter tip in the inferior SVC. Enlarged internal mammary lymph nodes are present. For example, left internal mammary lymph node (series 3, image 53) measures 0.9 x 1.3 cm and demonstrated increased activity on recent PET. CHEST WALL: There is redemonstration of a large soft tissue mass compatible with biopsy-proven lymphoma which occupies and destroys the majority of the scapula, including the body, coracoid, and glenoid. Lesion is not entirely included in the field of view, please see CT upper extremity 2/14/2015 for additional characterization. Inferior and superior to this mass, numerous additional soft tissue masses are noted along the chest wall, likely also representing lymphoma. For reference, one of the larger discrete inferior left axillary masses (series 3, image 41) measures 8.1 x 10.9 cm.There is also right axillary lymphadenopathy.There is nonspecific skin thickening of the bilateral breasts.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild lateral abdominal wall soft tissue edema, left greater than right.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Redemonstration of destructive soft tissue mass involving the left shoulder and axilla compatible with patient's known lymphoma. Additional right axillary and internal mammary lymphadenopathy.2.No lymphadenopathy identified in the abdomen or pelvis.3.Mild lateral left greater than right anasarca.4.Nonspecific bilateral breast skin thickening. |
Generate impression based on findings. | Reason: r/o ischemia History: occipital HA Neck CTA: There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.The visualized lung apices demonstrate airspace opacities.There are mild injection was in the cervical spine with anterior osteophytes present at C5-6 and C6-7 but unchanged since prior exam. There is some reflux of injected contrast contrast into left vertebral vein and epidural venous plexus. There is no obvious venous obstruction appreciated on this exam to account for itBrain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are intact. The left posterior communicating artery is a medium size. The right posterior communicating artery is small. The anterior communicating artery is small.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for aneurysm.2.No evidence for cervicocerebral occlusive disease.3.There are significant air space opacities in the visualized lungs appear differential considerations include pulmonary edema, but pneumonia as well as other considerations paraplegia for to chest CT for further comments. |
Generate impression based on findings. | 45 years, Female. Reason: eval NG placement after advancement History: none NG tube has been advanced with tip projecting over the gastric fundus. Center venous catheter tip projects over the superior cavoatrial junction. Diffuse, air distended loops of small and large bowel. Note that the pelvis is excluded from the field-of-view. | NG tube tip projects over the gastric fundus. Ileus type bowel gas pattern. |
Generate impression based on findings. | 59 years, Male. Reason: history of esophogeal cancer s/p stent, persistent nausea and vomiting History: persistent nausea and vomiting Nonobstructive bowel gas pattern with residual enteric contrast noted in the colon. Esophageal stent in the distal esophagus traverses the gastroesophageal junction and appears to be in similar location compared to prior CT scan. Small bilateral pleural effusions. | Nonobstructive bowel gas pattern. Esophageal stent in the distal esophagus is unchanged in location compared to prior CT. |
Generate impression based on findings. | 71 year-old female with confusion The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. Atherosclerotic calcifications are present along the distal internal carotid arteries. Incidental note is made of partial empty sella. | No CT evidence for acute intracranial hemorrhage, mass effect, or edema. |
Generate impression based on findings. | 85 year-old female with diffuse abdominal pain, evaluate for ischemic colitis. ABDOMEN:LUNG BASES: Basilar subsegmental opacities suspicious for aspiration and/or pneumonia. Small right pleural effusion. Severe coronary artery calcifications. Enteric contrast present in the esophagus.LIVER, BILIARY TRACT: Status post cholecystectomy. Mild intrahepatic biliary ductal dilatation is unchanged. Cirrhotic liver morphology. No focal enhancing lesions. New perihepatic ascites. SPLEEN: Absent spleen.PANCREAS: Atrophic pancreas.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts are again noted. Left cortical scarring. Poorly enhancing kidneys.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic calcifications of the abdominal aorta and branches.BOWEL, MESENTERY: The small bowel demonstrates diffuse mild dilation and a small bowel feces sign likely related to delayed transit from downstream colitis. Interval development of colonic dilation measuring up to 6 cm diameter with associated colonic submucosal edema and mucosal hyperenhancement involving the descending colon, transverse colon, splenic flexure. There is a possible transition point (series 4, image 45) beyond which the descending colon is collapsed. Small amount of abdominal free fluid. No intraperitoneal free air.BONES, SOFT TISSUES: Severe degenerative changes affect the visualized thoracolumbar spine. Anterior abdominal wall hernia repair mesh.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterus atrophic or absent. BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: The small bowel demonstrates diffuse mild dilation and a small bowel feces sign likely related to delayed transit from downstream colitis. Interval development of colonic dilation measuring up to 6 cm diameter with associated colonic submucosal edema and mucosal hyperenhancement involving the descending colon, transverse colon, splenic flexure. There is a possible transition point (series 4, image 45) beyond which the descending colon is collapsed. Small amount of abdominal free fluid. No intraperitoneal free air.BONES, SOFT TISSUES: Severe degenerative changes affect the visualized thoracolumbar spine and bilateral hips.OTHER: No significant abnormality noted | 1.New colonic dilation with associated colonic wall thickening of the proximal colon through the splenic flexure compatible with severe colitis secondary to infectious, inflammatory, or ischemic etiologies. Correlate clinically for toxic megacolon. 2.Right basilar opacities suspicious for aspiration and/or pneumonia with associated small pleural effusion.3.Cirrhotic liver morphology with new perihepatic ascites. 4.Poorly enhancing kidneys suggesting parenchymal dysfunction. |
Generate impression based on findings. | 45 years, Female. Reason: insertion of NG tube History: see above NG tube side-port is above the GE junction with tip projecting over the proximal gastric body. Diffuse, air distended loops of small and large bowel. Note that the pelvis is excluded from the field-of-view. | NG tube side-port is above the GE junction, advancement is recommended. |
Generate impression based on findings. | Reason: sob History: sob PULMONARY ARTERIES: There is no evidence of pulmonary embolism. The main pulmonary artery is slightly large 32 mm and there is contrast reflux into the IVC, but there is no other evidence right heart strain LUNGS AND PLEURA: Nonspecific basilar atelectasis may be from underinflation or mucous plugging, but there is no reliable evidence of infection. There are no significant sized pleural effusions.Lung volumes are small with bilateral hemidiaphragm elevation or eventration.MEDIASTINUM AND HILA: The heart is at least moderately enlarged.There are no visible coronary calcifications, and there is no sign of pericardial fluid. ETT tip 3 cm above the carina.CHEST WALL: Degenerative abnormalities affect the thoracic spine, and there is evidence of renal osteodystrophy.Soft tissue edema is present right more extensive than left.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No evidence pulmonary embolism.2. Possible pulmonary arterial hypertension.3. Basilar atelectasis without infection.3. Mild anasarca, which could be related to the patient's known renal failure. PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 63 years, Female. Reason: rfo History: bedside lap Enteric feeding tube projects over the pyloric area. Mildly dilated loops of small bowel in the midabdomen. Skin staples and surgical drain project over the right lower quadrant and are incompletely visualized. The pelvis is excluded from field of view. No unexpected radiopaque foreign objects. | No unexpected radiopaque foreign objects.Findings discussed with Dr. Andrew Lee via telephone at 1:44 PM on 2/20/2015 by Dr. Thomas. |
Generate impression based on findings. | 70 years, Male. Reason: DHT placement History: DHT placement Dobbhoff tube tip projects over the proximal gastric body. Partially visualized pacer leads are in place. Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. Calcified subcarinal lymph node is again noted. | Dobbhoff tube tip projects over the proximal gastric body. |
Generate impression based on findings. | 30 year-old male with breakthrough seizures Redemonstrated is marked dilatation of the bilateral lateral ventricles, right greater than left, with the encephalomalacia of the entire right hemisphere, as well as the anterior left frontal lobe. The third ventricle is also enlarged. There are stable postoperative findings compatible with a prior right frontoparietal craniotomy. Scattered metallic densities within the calvarium as well as in the left temporal extracranial soft tissues compatible with bullet fragments are again noted, and there are also bone fragments within the calvarium, likely related to the prior gunshot wound. There is a round defect in the left frontal bone likely representing the entrance site of the bullet. There is no acute intracranial hemorrhage. The imaged paranasal sinuses and mastoid air cells are clear. The orbits are intact. | No interval new CT evidence of acute intracranial process to explain the patient's symptoms. Stable multiple abnormalities as described in detail above. |
Generate impression based on findings. | Reason: 33 y/o f with h/o HIV and LIP presents with respiratory failure, eval for infection/LIP recurrence. History: shortness of breath LUNGS AND PLEURA: New extensive bilateral air space opacities throughout the lungs, with a predominantly groundglass texture, and there is a basilar consolidation.Trace bilateral pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size without pericardial fusion. No visible coronary artery calcification. The main pulmonary artery is enlarged, suggestive of pulmonary hypertension.No mediastinal or hilar lymphadenopathy.ET tube in place. Nasogastric tube extends into the stomach.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | New diffuse groundglass opacity and areas of basilar consolidation in a patient with HIV, suggestive of pneumocystis pneumonia. Findings are somewhat similar to the prior exam dated 01/2007 one patient was diagnosed with diffuse infiltrative lymphocytosis syndrome of HIV. |
Generate impression based on findings. | 39-year-old male with headache White matter foci of T2 hyperintensity identified on prior brain MRI are not well visualized with current CT technique. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | No acute intracranial process to explain the patient's symptoms. |
Generate impression based on findings. | 21 years, Male. Reason: bowel obstruction, dilatation History: bloody stools Nonobstructive bowel gas pattern. Slightly above average stool burden in the ascending colon. Bowel wall thickening in the ascending and transverse colon is nonspecific and may represent colitis. Enlarged spleen noted. | Nonobstructive bowel gas pattern. Bowel wall thickening in the ascending and transverse colon is nonspecific and may represent colitis. |
Generate impression based on findings. | 75-year-old male who fell 3 times with head injury Soft tissue swelling is noted over the left forehead, extending to the superior left periorbital soft tissues. There are no underlying associated calvarial or parenchymal abnormalities.There is stable prominence of the ventricular system. Redemonstrated is an incidental cavum septum pellucidum. There is no intracranial mass, fluid collection or hemorrhage. Gray-white matter differentiation is maintained bilaterally and the midline is intact.The left maxillary sinus is near completely opacified with a superimposed air-fluid level, however this has demonstrated slight interval improvement. The remaining visualized paranasal sinuses and mastoid air cells are clear. | Soft tissue swelling is noted over the left forehead, extending to the superior left periorbital soft tissues. There are no underlying associated calvarial or parenchymal abnormalities. |
Generate impression based on findings. | Female 27 years old Reason: facture History: swelling, pain. We have 4 views of the facial bones which show no fracture. The paranasal sinuses are unremarkable. | No fracture of the facial bones. If further imaging is clinically warranted, CT is recommended. |
Generate impression based on findings. | Brain: Large left frontal scalp hematoma without evidence of calvarial fracture. No acute intracranial hemorrhage, mass-effect, or midline shift. Moderate prominence of the ventricles and sulci, most likely age related volume loss. Moderate periventricular and subcortical white matter hypoattenuation most likely age indeterminate small vessel ischemic disease. There are no extraaxial fluid collections or subdural hematomas. Right maxillary sinus osteoma. The visualized portions of the paranasal sinuses and mastoid air cells are clear. Spine: Alignment is anatomic. Vertebral body heights are well- maintained without evidence of fracture or traumatic subluxation. C2/3: Mild posterior disk osteophyte complex without evidence of significant central spinal canal stenosis. C3/4: Mild posterior disk osteophyte complex and facet arthropathy without evidence of significant central spinal canal stenosis.C4/5: Mild posterior disk osteophyte complex and facet arthropathy with mild left neural foraminal narrowing. No significant central spinal canal stenosis.C5/6: Mild to moderate posterior disk osteophyte complex with mild bilateral foraminal hypertrophy without central spinal canal stenosis. C6/7: Mild posterior disk osteophyte complex and bilateral facet arthropathy without significant central spinal canal stenosis.C7/T1: No significant central spinal canal stenosis. | 1. Left frontal scalp hematoma without evidence of intracranial hemorrhage.2. Multilevel degenerative changes as above without evidence of fracture or traumatic subluxation. |
Generate impression based on findings. | The ventricles and sulci are normal for age. The cisterns are symmetric and unremarkable. The gray-white matter differentiation is preserved. Periventricular and subcortical hypoattenuation consistent with age indeterminate ischemic small vessel disease. There is no mass effect, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. There is a partially empty sella. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | Periventricular and subcortical hypoattenuation consistent with age indeterminate ischemic small vessel disease. If there is continued clinical concern for acute ischemia, MRI would be recommended. |
Generate impression based on findings. | Female 34 years old Reason: fx History: pain We have 3 views of the right foot which show an oblique fracture through the diaphysis of the fifth metatarsal with the fracture fragments in near anatomic alignment. Note is made of a bipartite medial sesamoid bone, likely a normal variant.Three views of the ankle show a small ossicle along the dorsal aspect of the talus that presumably represents a small os trigonum. However, if there is strong clinical concern for fracture, CT may be considered. | Fifth metatarsal fracture and other findings as above. |
Generate impression based on findings. | Female 63 years old Reason: sob History: sob. POD#5 s/p open repair of incarcerated umbilical hernia. ABDOMEN:LUNG BASES: Please refer to CT PE study from the same day for additional thoracic findings. LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Nonspecific heterogeneity in the tail of the pancreas which is not well assessed secondary to motion artifact.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small bilateral kidneys with cystic changes. The exam is suboptimal secondary to imaging artifact. Within these limitations, there are small heterogeneous wedge-shaped parenchymal regions which may represent infarctions. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mildly dilated loops of small bowel measuring up to 3.5 cm. There is no definite transition point and the findings likely represent a postoperative ileus. The cecum is unusually located in the left lower quadrant, consistent with a likely nonobstructive distal midgut malrotation. Signs of nonobstructive adhesion disease especially in the left upper quadrant. The colon is underdistended making the examination suboptimal. No pneumatosis or intraperitoneal free air.BONES, SOFT TISSUES: Postoperative changes from ventral hernia repair with a subcutaneous drain and skin staples. There is soft tissue induration and a small subcutaneous fluid collection in the anterior right lower quadrant. No definite evidence of abscess. Degenerative changes of the visualized spine.PELVIS:UTERUS, ADNEXA: Hyperdense soft tissue focus located inferiorly between the urethra and rectum which most likely represents a partially calcified uterus which has prolapsed.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of the visualized spine.OTHER: Left femoral arterial and right femoral venous line are in place. | 1.Dilated loops of small bowel likely representing postoperative ileus. No pneumatosis or intraperitoneal free air.2.Postoperative changes as above.3.Prolapsed uterus suspected.Preliminary findings were discussed with Dr. Lee by the radiology resident on call. |
Generate impression based on findings. | 9-year-old male status post ET tube placement, evaluate for interval change.VIEW: Chest AP (one view) 2/20/2015 at 0259 Two right-sided pigtail catheters are again noted, one terminating in the medial aspect of the right hemidiaphragm and the other in the right lower lobe. ET tube tip is between the thoracic inlet and the carina. Feeding tube tip in the stomach. Left central venous catheter tip in SVC. Right PICC tip in right subclavian vein. There is persistent complete opacification of the left hemithorax, secondary to massive left pleural effusion and associated atelectasis. Right lung aeration is within normal limits. | Persistent complete opacification of the left hemithorax, secondary to large left pleural effusion and associated atelectasis. |
Generate impression based on findings. | Reason: r/o pe History: sob with elevated dimer PULMONARY ARTERIES: No evidence of pulmonary embolism. The main pulmonary artery is normal in caliber.LUNGS AND PLEURA: Scattered benign appearing micronodules. No suspicious pulmonary nodules or masses.No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. No visible coronary artery calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted, except for a partially visualized non-obstructing left renal calculus. | No evidence of pulmonary embolism or other acute abnormality.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | HIV with SOB, also follow up on nodule on previous CT. LUNGS AND PLEURA: Interval near complete resolution of previously seen dense airspace opacity in the right upper lobe, which was most likely of an infectious etiology. Due to adjacent atelectasis and small amount of fluid in the major fissure, this area is incompletely evaluated.Mild interlobular septal thickening and faint groundglass opacities exaggerated by expiratory phase of technique, suggestive of very mild pulmonary edema. Diffuse bronchial wall thickening is new.Left upper lobe small cystic area, unchanged and likely a pneumatocele.No specific evidence of pneumonia.Extensive bibasilar subsegmental atelectasis and/or scarring.MEDIASTINUM AND HILA: Scattered small dense mediastinal lymph nodes, unchanged. No hilar lymphadenopathy.Moderate coronary artery calcification. Low-density blood pool consistent with anemia.No pericardial effusion.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Trace perihepatic ascites. | 1. Interval near complete resolution of right upper lobe dense airspace opacity, which was likely infectious in etiology. This can be conservatively followed with a chest PA/lateral radiograph in 3 months.2. Mild interlobular septal thickening with faint groundglass opacities suggestive of very mild pulmonary edema. New diffuse bronchial wall thickening is nonspecific, may be due to CHF or infection. |
Generate impression based on findings. | Male 68 years old Reason: possibly broken PICC line. History: as above. We see no radiopaque foreign body to suggest a retained PICC fragment. Mild osteoarthritis affects the shoulder. | No findings to suggest retained PICC fragment. |
Generate impression based on findings. | Redemonstrated is a stable right parietal approach ventriculostomy catheter with tip across midline in the region of the left lateral ventricle. There is no evidence of acute intracranial hemorrhage. Overall, severe ventriculomegaly is unchanged. The mastoid air cells are clear. Calvarial deformation is stable. | Stable ventriculostomy catheter with no change of ventriculomegaly. No acute intracranial hemorrhage. |
Generate impression based on findings. | 7-week-old female with 3 days intermittent abdominal pain and crying, no stoolsVIEWS: Abdomen, AP and lateral (two views) 2/19/15 23:11 Disorganized bowel gas pattern without evidence of obstruction. No bowel wall pneumatosis or free intraperitoneal air. | Normal examination. |
Generate impression based on findings. | Reason: eval for infection History: cough, dyspnea LUNGS AND PLEURA: Upper lobe predominant ground glass opacities spearing the lung periphery and bases.No pleural effusions identified.Minimal basilar scarring or subsegmental atelectasis is present.Focal ill-defined nodule right middle lobe contains a central lucency but this likely is a dilated bronchus extending through this region. MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy.No coronary calcifications are identified, and the heart and pericardium appear normal.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Upper lobe predominant ground glass opacities appear acute, with no pleural effusions identified. While pneumocystis pneumonia is a possibility, the marked upper lobe predominance is atypical. Other considerations include drug reaction, viral infection or idiopathic pulmonary hemorrhage. |
Generate impression based on findings. | 9 year-old male with history of Fanconi syndrome and Wilms tumor. CHEST:LUNGS AND PLEURA: There is a massive left pleural effusion with overlying compressive atelectasis. Multiple low attenuation areas within the collapsed lung do not demonstrate contrast enhancement and may be necrotic.New subpleural right lower lobe micronodules, the largest of which measures 5 mm (series 80214, image 47). Scattered streaky opacities in the right lung are compatible with surrounding atelectasis. Two right chest tubes are noted, one terminating in the medial aspect of the right hemidiaphragm and the other in the right lower lobe. ET tube tip is between the thoracic inlet and the carina. MEDIASTINUM AND HILA: Normal heart size without significant pericardial effusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: Left central venous catheter tip in the SVC. Right PICC tip in right subclavian vein. No axillary lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: Status post right hepatectomy. No focal hepatic lesions or biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Status post left nephrectomy. Right kidney is normal in appearance.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal or mesenteric lymphadenopathy.BOWEL, MESENTERY: Feeding tube tip in the stomach. Mild dilatation of the sigmoid and descending colon as well as the hepatic flexure. Mural hyperenhancement involving the transverse colon, splenic flexure, and descending colon may represent an ischemic, infectious, or inflammatory process. No free air.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter enters the bladder.LYMPH NODES: No significant pelvic lymphadenopathy.BOWEL, MESENTERY: Please see discussion above.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Moderate pelvic ascites. | 1.Large left pleural effusion; overlying collapsed lung demonstrates areas of decreased enhancement that may represent necrosis.2.New right lower lobe subpleural micronodules, considered nonspecific given surrounding atelectasis. 3.Mural hyperenhancement of the transverse and descending colon, for which differential considerations include infectious/inflammatory as well as ischemic etiologies.4.Nonspecific mild dilatation of the sigmoid and descending colon and moderate pelvic free fluid. |
Generate impression based on findings. | 1-year-old female with Fanconi anemia, MDS status-post stem cell transplant with increased work of breathingVIEW: Chest AP (one view) 2/19/15 22:56 Tracheostomy tube tip at thoracic inlet. Right central venous catheter tip in the SVC. Left PICC tip in the right atrium.The cardiothymic silhouette is normal. Mild retrocardiac atelectasis without evidence of pneumonia or pleural effusion. Surgical material in the upper abdomen, and gastrostomy tube are again noted. | Mild retrocardiac atelectasis without evidence of pneumonia. |
Generate impression based on findings. | History of parasagittal meningioma, preoperative planning Examination is obtained for operative planning. Again seen is extra-axial mass along the right aspect of the falx involving the posterior frontal lobe measuring 4.3 x 3.4 x 3.7 cm in the AP, transverse, and craniocaudal dimensions. There is homogeneous enhancement. There is foci of calcifications associated with the tumor, particularly in its most superior aspect. Mass abuts the superior sagittal sinus which remains patent and without clear evidence of invasion. There is surrounding hypodensity involving the right frontal lobe extending into the right parietal lobe compatible with vasogenic edema. There is an associated mass-effect particularly on the right precentral gyrus. There is also down or mass-effect on the cingulate gyrus and the posterior body of the callosum. Posterior to this larger mass is a small right parietal extra-axial lesion measuring approximately 1 cm in diameter along the right aspect of the posterior falx with foci of calcifications and compatible with an additional meningioma.No intracranial hemorrhage. Minimal leftward midline shift at the high convexity. No transtentorial herniation. Remainder of the brain parenchyma demonstrates scattered areas of hypoattenuation in the periventricular and subcortical white matter, which are nonspecific but compatible with chronic small vessel ischemic changes. No hydrocephalus. No extra-axial fluid collections. Calvarium is intact.Multiple scalp nodules are noted including the left frontal scalp anteriorly, the left parietal scalp, right frontal scalp, and in the occipital region.There is mild opacification of left ethmoid air cells. The visualized portions of the paranasal sinuses are otherwise clear. Mastoid air cells are clear. | 1. Examination for operative planning again demonstrates 4.3 x 3.4 x 3.7 cm enhancing mass most compatible with a parasagittal meningioma. Additional 1 cm meningioma is seen slightly more posteriorly.2. Multiple scalp nodules which are nonspecific and may represent lesions such as sebaceous cysts. |
Generate impression based on findings. | Male 44 years old Reason: SBO History: abdominal pain, h/o abdominal surgeries. History of Crohn's with prior ileocecectomy. 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: Mild right hydronephrosis with delayed nephrogram seen. The right ureter is not clearly seen beyond the level of the tethered small bowel loops in the right lower quadrant. RETROPERITONEUM, LYMPH NODES: Mildly enlarged mesenteric lymph nodes measuring up to 1 cm in the right lower quadrant.BOWEL, MESENTERY: Dilated small bowel loops measuring up to 8 cm in the left upper quadrant/pelvis. There is wall thickening and enhancement of a long segment of distal small bowel consistent with active inflammation. The transition point is located in the right lower quadrant and best visualized on coronal imaging (series 80296, image 53) and also visualized on axial images (series 3, images 102-120). This correlates with area of stricturing seen on the small bowel study from 2012, although the degree of bowel dilatation has increased since that prior study. Underlying tethering of bowel is present. No definite extraluminal air.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedBOWEL, MESENTERY: The colon is collapsed in the right lower quadrant..BONES, SOFT TISSUES: No significant abnormality noted | 1.Findings consistent with small bowel obstruction with both acute and chronic components.2.Mild right hydronephrosis which may be secondary to ureteral obstruction by tethered bowel.Additional nonemergent findings were discussed by telephone with the clinical service, Dr. Paul Schultz, at 9:45 a.m. on 2/20/2015. |
Generate impression based on findings. | Reason: New PE? History: Chest pain, SOB, h/o PE PULMONARY ARTERIES: Exam is somewhat limited by suboptimal contrast opacification of the pulmonary arteries. No evidence of pulmonary embolism to the segmental level. The pulmonary emboli seen on the prior exam dated 1/6/2015 are not seen on this exam.The main pulmonary artery is normal in caliber.LUNGS AND PLEURA: Surgical changes in the local resection in the medial right lower lobe.No suspicious pulmonary nodules or masses.Stable mild bronchial wall thickening.Mild subsegmental basilar atelectasis/scarring, and mild dependent atelectasis. No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is mildly enlarged, without pericardial effusion. Mild coronary artery calcification.Increased fullness in the precarinal and subcarinal regions, may represent lymphadenopathy.CHEST WALL: Mild degenerative disease of the thoracic spine. Cervical spinal fixation hardware is partially visualized.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. No evidence of pulmonary embolism or other acute abnormality.2. Increased fullness in the precarinal and subcarinal regions, somewhat suspicious for adenopathy in a patient with a history of lung cancer. Recommend followup PET-CT imaging for additional evaluation.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 11-month-old male with fever and vomitingVIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views), abdomen AP/lateral (two views) 2/20/15 0:22 Midface hypoplasia and deformity of the head with wormian bones is again noted. Right intracranial shunt catheter with its tip projecting across the midline is unchanged in position. The extracranial VP shunt catheter courses down the right neck, anterior chest wall and abdomen, with its tip in the right upper quadrant. No evidence of kinking or discontinuity of the radiopaque portions of the shunt catheter.The cardiothymic silhouette size is normal. Note is made of bifid ribs in the left hemithorax. No focal pulmonary opacities or pneumothorax. Normal abdominal gas pattern. | No evidence of VP shunt malfunction. |
Generate impression based on findings. | Reason: 62 yof w/ right heart failure, COPD, worsening hypoxia, RV dilated on echo. Concern for PE History: hypoxia PULMONARY ARTERIES: No evidence of pulmonary embolism to the segmental level. The main pulmonary artery is over 3 cm, but still smaller than the ascending aorta. There is some straightening of the intra-atrial septum with a large right atrium and reflux of contrast material into the hepatic veins, suggestive of right heart strain.LUNGS AND PLEURA: Moderate upper lobe centrilobular predominant emphysema.Increased dependent opacities suggestive of edema and atelectasis, and possibly aspirated secretions on the left. MEDIASTINUM AND HILA: Nonspecific mediastinal lymphadenopathy is unchanged, involving the right paratracheal, prevascular and subcarinal regions.Mild coronary artery calcifications are present, and the heart is at least moderately enlarged.A right jugular catheter terminates in the RA. CHEST WALL: Degenerative abnormalities affect the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Contrast material refluxes into the liver consistent with right heart failure/right heart strain. | 1. No evidence of pulmonary embolism to the segmental level, but there appears to be right heart strain.2. Dependent opacities suggestive of aspirated secretions or edema/atelectasis, with underlying emphysema. PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Positive. |
Generate impression based on findings. | Female, 78 years old, with back pain and L4-5 stenosis in 2010. Grade 1 anterolisthesis of L4 relative to L5 is similar to prior. Alignment of the remaining vertebral bodies is within normal limits. Vertebral body is unremarkable. No fractures or destructive osseous lesions are seen. L1-2: Mild facet hypertrophy. Ligamentum flavum thickening and calcification. Slight effacement of the posterolateral thecal sac. No significant spinal canal or neuroforaminal stenosis. No significant interval changes. L2-3: Mild facet hypertrophy. Ligamentum flavum thickening and calcification. Slight effacement of the posterolateral thecal sac. No significant spinal canal or neuroforaminal stenosis. No significant interval changes.L3-4: Mild facet hypertrophy with vacuum phenomenon. Moderate ligamentum flavum thickening. Mild bulging disk. Mild generalized spinal canal narrowing which is stable to at most minimally progressed. Mild bilateral foraminal narrowing, unchanged. L4-5: Marked facet hypertrophy with vacuum phenomenon on the left slightly progressed. Ligamentum flavum thickening. Disk bulging and uncovering. Moderate generalized spinal canal stenosis, not significantly changed. Moderate to severe spinal canal narrowing. L5-S1: Marked facet hypertrophy. Mild bulging disk, not significantly changed. No significant generalized spinal canal stenosis. Severe bilateral neuroforaminal narrowing, not significantly changed. A left renal cystic lesion is redemonstrated now measuring up to 25 mm in diameter, previously 10 mm. Aortoiliac atherosclerotic calcifications are seen. | Stable to at most mildly progressed degenerative findings as discussed above. In particular, there has been no significant interval change in the spinal canal stenosis at L4-5.A cystic lesion within the left kidney has significantly increased in size since the prior examination. Although the imaging characteristics as visualized on this exam are not aggressive in appearance, this lesion is not fully evaluated on noncontrast CT. Dedicated imaging with a renal protocol CT or MRI is suggested. |
Generate impression based on findings. | Pain. Preop. Transverse CT images through the hips again reveals left hip osteoarthritis. Similar osteoarthritis affects the right hip. Mild degenerative arthritis affects the pubic symphysis and sacroiliac joints. Degenerative disk disease and facet joint osteoarthritis affect the visualized lower lumbar spine. Chronic enthesopathic changes are noted along the iliac crests and ischii. The soft tissues are unremarkable on this non-enhanced exam.Transverse images through the knees show severe arthritis of the left knee with a small to moderate sized knee joint effusion. Evaluation of the right knee is limited by metallic stability artifact due to the patient's total knee arthroplasty. | Osteoarthritis and other findings as above. As this represents completion of an exam from February 12, 2015, the patient will not be charged for today's study.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 14-month-old male status post trauma with lacerationVIEWS: Right foot, AP, oblique, and lateral (3 views) 2/20/15 0:41 Limited AP view due to overlying hand. Alignment is anatomic. There is soft tissue swelling along the dorsum of the foot with no discrete fracture visualized. | Soft tissue swelling without fracture or dislocation. |
Generate impression based on findings. | Pain. Two views of the left humerus demonstrate a plate and screw device affixing a comminuted but predominantly transverse fracture of the mid diaphysis in near anatomic alignment. We see no radiographic evidence of hardware complication. Callus formation adjacent to the fracture indicates some interval healing. | Orthopedic fixation of a healing humerus fracture. |
Generate impression based on findings. | Shoulder pain. Three views of the right shoulder demonstrate mild osteoarthritis affecting the glenohumeral joint and moderate osteoarthritis affecting the acromioclavicular joint. | Osteoarthritis. |
Generate impression based on findings. | Lumbar pain There is angulation of the upper lumbar spine to the left which may reflect scoliosis or artifact of patient positioning.Mild degenerative disk disease affects L3/L4, L4/L5, and L5/S1. There is no spondylolisthesis. | Degenerative disk disease and other findings as above. |
Generate impression based on findings. | Reason: evaluate s/p left temporal cavernous malformation resection History: evaluate s/p left temporal cavernous malformation resection The patient is status post recent left-sided craniotomy for a left inferomedial temporal lobe fusiform gyrus lesion. There is adjacent hypodensity along the left fusiform gyrus. There is associated intracranial air redemonstrated.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.Expected recent postoperative findings related tocraniotomy for resection of a left fusiform gyrus cavernous malformation, without evidence of acute intracranial hemorrhage . |
Generate impression based on findings. | Right hip pain Moderate osteoarthritis affects the right hip. Prominence of the right femoral anterolateral head neck junction is compatible with a cam deformity.Components of a left total hip arthroplasty device are situated in near-anatomic alignment without radiographic evidence of hardware complication.Degenerative arthritic changes affect the visualized lower lumbar spine. | Osteoarthritis. |
Generate impression based on findings. | 16 year old female with pseudotumor cerebriVIEWS: Shunt series: Abdomen AP/lateral (two views) 2/19/15 15:51 Lumboperitoneal shunt catheter with its proximal tip in the lower thoracic spinal canal is again visualized without evidence of kinking or discontinuity. The shunt exits the canal and courses down the right back and abdomen, with its tip in the pelvis. The Codman Hackim valve setting is not well evaluated on the lateral view. Nonobstructive bowel gas pattern with moderate rectal stool burden. | No evidence of kinking or discontinuity of the radiopaque portions of the shunt catheter. |
Generate impression based on findings. | There is new mucosal thickening in the maxillary sinuses, right greater than left. Bilateral ostiomeatal units are narrowed, yet remain patent.Bilateral sphenoid and ethmoid sinuses as well as sphenoethmoidal and frontoethmoidal recesses are clear, unchanged.There is a new, solitary small focus of mucosal thickening within the inferomedial right frontal sinus.Bilateral mastoid air cells and middle ear cavities and there are no air-fluid levels. Note is again made of bilateral Haller cells. The lamina papyracea are intact bilaterally. The floor of the anterior cranial fossa and cribriform plate region are unremarkable. The nasal septum is deviated rightward with a tiny right septal spur. Bilateral orbits and the posterior nasopharynx appear unremarkable. | 1.There is new mucosal thickening in the maxillary sinuses, right greater than left. Bilateral ostiomeatal units are narrowed, yet remain patent. There are no superimposed air-fluid levels.2.There is a new, solitary small focus of mucosal thickening within the inferomedial right frontal sinus. |
Generate impression based on findings. | Male 19 years old; s/p ORIF clavicle An intramedullary rod/screw affixes a fracture of the mid clavicular diaphysis in near-anatomic alignment. We see no radiographic evidence of hardware complication. Callus formation along the clavicle indicates some interval healing. | Orthopedic fixation of a healing clavicular fracture. |
Generate impression based on findings. | Cervical spine:Alignment is anatomic. Vertebral body height are well maintained without fractures or subluxations. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C1/2: No significant central spinal canal stenosis or neural foraminal narrowing.C2/3: No significant central spinal canal stenosis or neural foraminal narrowing.C3/4: No significant central spinal canal stenosis or neural foraminal narrowing.C4/5: No significant central spinal canal stenosis or neural foraminal narrowing.C5/6: Minimal disk bulge without significant central spinal canal stenosis or neural foraminal narrowing.C6/7: Minimal disk bulge without significant central spinal canal stenosis or neural foraminal narrowing.C7/T1: No significant central spinal canal stenosis or neural foraminal narrowing. | No significant central spinal canal stenosis as clinically questioned. |
Generate impression based on findings. | 4-year-old female with cough.VIEWS: Chest AP/lateral (two views) 2/19/2015 1649 Streaky right lower lobe and perihilar opacities may represent atelectasis or atypical infection. No pleural effusion or pneumothorax. Normal cardiothymic silhouette. Gaseous distention of the stomach. Median sternotomy wires, with new fracture of the 2nd wire when counting from the bottom. Small foci of residual contrast noted in the upper abdomen; these were also seen on prior studies and likely represent retained peritoneal contrast material from previous spillage. | 1.Streaky right lower lobe and perihilar opacities, which may represent atelectasis or atypical infection. 2.New fracture of the 2nd median sternotomy wire when counting from the bottom. |
Generate impression based on findings. | Female 19 years old; s/p ORIF A plate and screw device affixes a comminuted fracture of the distal fibular diaphysis in near-anatomic alignment. A small amount of adjacent callus formation indicates an attempt at healing. Two trans-syndesmotic screws affix the distal tibiofibular articulation in near-anatomic alignment. Two additional screws affix a fracture of the medial malleolus in anatomic alignment. The fracture line in the medial malleolus is indistinct, indicating some interval healing. We see no radiographic evidence of hardware complication. | Orthopedic fixation of healing distal fibular and tibial fractures. |
Generate impression based on findings. | Shoulder pain A round lucency in the proximal humeral metadiaphysis with sclerotic border likely represents postoperative defect of a prior biceps tenodesis. Tapering of the distal acromial process likely also indicates prior surgery. No other findings are seen to account for the patient's pain. | Postoperative changes as above. Otherwise no findings to account for the patient's pain. |
Generate impression based on findings. | 2-year-old male with large left liver mass on ultrasound. CHEST:LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. No focal airspace opacity or pleural effusion. Mild dependent atelectasis. MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: There is a large solid hypodense mass demonstrating lobulated contours and heterogeneous contrast enhancement which occupies a majority of the left liver lobe and extends into the right liver. This mass measures 8.3 x 6.8 x 10.3 cm, TR x AP x CC (series 8, image 46 and series 80539, image 57). Findings correspond to those seen on recent prior ultrasound. No biliary ductal dilatation.The mass is supplied by several branches of the left hepatic artery. The hepatic arteries, portal vein, hepatic veins, and IVC are all patent. The middle hepatic vein is visualized but demonstrates significant posterior displacement, which likely explains why it was not seen on recent prior ultrasound. The left hepatic vein drapes along the left lateral edge of the aforementioned solid mass. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant retroperitoneal or mesenteric lymphadenopathy.BOWEL, MESENTERY: No bowel obstruction or free air.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.Large solid hypodense mass occupying a majority of the left liver as described above. Findings correspond to those seen on recent prior ultrasound and likely represent hepatoblastoma. Please correlate with AFP levels. 2.Patent hepatic vasculature as described above. No definite evidence of metastatic disease. |
Generate impression based on findings. | Strep pneumonia sepsis planned for extubationVIEW: Chest AP 2/20/15 ET tube tip immediately above carina. NG tube tip in the stomach. Right central line tip in the right atrium. Cardiothymic silhouette normal. Minimal patchy atelectasis left lower lobe. No pleural effusion or pneumothorax. | Minimal patchy atelectasis left lower lobe. |
Generate impression based on findings. | Pain Four views of the right elbow are provided. Again seen is a fracture of the radial head/neck in near-anatomic alignment. Adjacent callus formation indicates some interval healing. Soft tissue swelling is present particularly at the medial aspect of the elbow.Three views of the right shoulder are provided. Mild osteoarthritis affects the acromioclavicular joint. Surgical clips are present in the axilla. Fractures of the lateral aspects of the right third, fourth, and fifth ribs are seen, unchanged from the prior chest radiograph. | 1. Healing radial head/neck fracture.2. Mild osteoarthritis of the acromioclavicular joint.3. Right-sided rib fractures appearing similar to the prior study. |
Generate impression based on findings. | Postop cardiac surgeryVIEW: Chest AP 2/20/15 Right central line, right chest tube and epicardial pacer leads again noted. Cardiothymic silhouette at the upper limits of normal. Minimal patchy atelectasis in the right middle lobe and left lower lobe. No pleural effusion or pneumothorax. | Patchy atelectasis bilaterally unchanged. |
Generate impression based on findings. | Increased oxygen requirementVIEW: Chest AP 2/20/15 Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. Patchy atelectasis bilaterally in a background of chronic lung disease. No pleural effusion or pneumothorax. | Patchy atelectasis bilaterally in a background of chronic lung disease. |
Generate impression based on findings. | Male 42 years old; Reason: evaluate small left testicular mass, lower pole History: none RIGHT TESTIS: The right testis measures 5.9 x 4.2 x 2.4 cm. It is normal in ultrasound appearance. There is no worrisome mass.LEFT TESTIS: The left testis measures 5.8 x 3.8 x 2.5 cm. It is normal in ultrasound appearance. There is no worrisome mass.RIGHT EPIDIDYMIS: The right epididymis measures 1.5 x 1.5 x 1.2 cm, the head of the epididymis contains a 0.4 x 0.5 x 0.4 cm simple cyst.LEFT EPIDIDYMIS: The left epididymis measures 3.4 x 1.3 x 1.7 cm, and contains multiple cysts, the largest measures 0.6 x 0.6 x 0.6 cm. Adjacent to the inferior aspect of the left testicle in the area of the palpated abnormality indicated by the patient is a 0.5 x 0.6 cm structure with a similar appearance the epididymis. This is stable in size and appearance when compared to the prior outside ultrasound however on the current study this structure is clearly separate from the testicle.OTHER: Adjacent to the inferior aspect of the left testicle in the area of the palpated abnormality indicated by the patient is a 0.5 x 0.6 cm structure with a similar appearance the epididymis. This is stable in size and appearance when compared to the prior outside ultrasound however, on the current study this structure is clearly separate from the testicle.There is a small left hydrocele and small left varicocele similar to the prior study.. | 1.Normal ultrasound appearance of the testicles bilaterally. 2.0.5 x 0.6 cm structure inferior to the left testicle has a similar ultrasound appearance to the epididymis and is separate from the testicle. This most likely represents a prominent epididymal tail.3.Bilateral epididymal cysts. |
Generate impression based on findings. | Reason: metastatic cancer to lung History: history of metastatic cancer to lung s/p RLL lobectomy and LUL lung resection. LUNGS AND PLEURA: Right lower lobectomy and apical sparing upper lobe resection.Just peripheral to the left bronchocele, scarlike soft tissue is slightly more prominent measuring 9 x 16 mm, previously 8 x 10-mm (4/105), though this could be due to surrounding radiation reaction this area should continue to be monitored. A triangular groundglass density scarlike lesion also peripheral to the bronchocele head is slightly more cranial level is not significantly changed (4/85). New left perihilar groundglass opacity and consolidation in the lower lobe near the level of the suture line presumably reflects acute radiation pneumonitis.Soft tissue nodule caudal to the right lower lobe resection site is decreased in size, now measuring 13 x 13 mm (series 4, image 174), previously measuring 18 x 15 mm. There is new scattered patchy groundglass and consolidation in this region, with a more nodular area of consolidation measuring 10 mm (series 5, image 64).A punctate left lower lobe nodule seen previously has resolved. Previously seen areas of pleural thickening and basilar subsegmental atelectasis/scarring are unchanged. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without significant pericardial effusion. Moderate coronary artery calcification.Scattered small mediastinal and hilar lymph nodes are unchanged from the prior exam.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Status post right nephrectomy. | Interval development of ground glass opacity and consolidation near the previously seen nodules, most likely reflecting acute radiation pneumonitis in the absence of clinical signs of infection. Measurements of index lesions detailed in the body of the report should, probably stable to slightly improved allowing for expected surrounding post therapeutic process. |
Generate impression based on findings. | History of severe persistent asthma, prior imaging showed peribronchial thickening. Assess for parenchymal lung disease. LUNGS AND PLEURA: Small amount of aspirated debris in the trachea and bilateral mainstem bronchi.Diffuse mild bronchial wall thickening consistent with asthma with scattered mucus plugging.Very mild apical scarring, unchanged.No bronchiectasis. No focal airspace consolidation or pleural effusion.Scattered micronodules, some new, most likely post-inflammatory.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Normal heart size without a pericardial effusion.No visible coronary artery calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Diffuse bronchial wall thickening with scattered mucus plugging consistent with history of asthma. No focal airspace opacity or pleural effusion. No bronchiectasis or large areas of mucus plugging to conclusively suggest ABPA. |
Generate impression based on findings. | RDSVIEW: Chest AP 2/20/15 ET tube tip below thoracic inlet and above the carina. NG tube tip at the GE junction. The umbilical arterial catheter is unchanged. Cardiothymic silhouette normal. Diffuse atelectasis bilaterally not significantly changed. No pleural effusion or pneumothorax. | Diffuse atelectasis bilaterally not significantly changed. |
Generate impression based on findings. | 14-year-old female with known bilateral duplicated collecting systems. BLADDER Wall Thickness: Normal Contents: Partially distended and normal. Distal Ureter -- SFU Grade** Right: 0 Left: 0 Ureteral Jets Right: Not observed Left: Not observedKIDNEYS Cortical Echogenicity: Normal Medullary Echogenicity: Normal Pelvicaliceal System -- SFU Grade* Right: 0 Left: 0 Length*** Right: 12.4 cm Left: 9.4 cm Mean for age: 9.9 cm Range for age: 8.5 - 11.1 cmADDITIONAL OBSERVATIONS: Bilateral duplicated collecting systems are identified, unchanged since 2008. | Bilateral duplicated collecting systems without hydronephrosis, not significantly changed.*SFU grading system: Grade 0: No hydronephrosis. Grade 1: The renal pelvis is visualized. Grade 2: A few but not all of the calices are identified in addition to the renal pelvis. Grade 3: Virtually all the calices are seen. Grade 4: Grade 3 and parenchymal thinning. **SFU grading system retrovesical ureter: Grade 0: No ureteral dilatation. Grade 1: Ureter less than 7 mm. Grade 2: Ureter is 7-10 mm. Grade 3: Ureter is over 10 mm. Fernbach SK, Maizels M, Conway JJ. Ultrasound Grading of Hydronephrosis: Introduction to the System used by the Society for Fetal Urology. Pediatric Radiology (1993) 23: 478-480.***Rosenbaum DM, Korngold E, Teele RL. Sonographic Assessment of Renal Length in Normal Children. AJR Am J. Roentgenol (1984) 142:467-469 |
Generate impression based on findings. | 50 year old woman with history of right breast masses seen on screening mammogram. Three standard views of both breasts and compression CC and ML views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Three lobulated masses in the central inferior right breast are unchanged in appearance and size, compatible with cysts. No new dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. | Multiple benign-appearing right breast masses compatible with cysts. Bilateral diagnostic mammogram is recommended in 12 months to confirm stability. Results and recommendations discussed with patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | FractureVIEWS: Left thumb AP, oblique and lateral The previously noted fracture involving the base of the proximal phalanx of the left thumb is obscured by overlying cast. | Fracture of the left thumb obscured by overlying cast. |
Generate impression based on findings. | 2-Year-old male with liver failure and encephalopathy, planning for extubationVIEW: Chest AP (one view) 2/20/15 5:39 ETT above the carina. Enteric tube tip and side-port in the stomach. Left PICC catheter tip at the cavoatrial junction. The cardiothymic silhouette is normal.Right upper lobe and retrocardiac atelectasis slightly increased from the prior exam. | Mildly increased right upper lobe and retrocardiac atelectasis. |
Generate impression based on findings. | Redemonstrated is levoscoliosis. There are no fractures. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.There has been prior posterior lumbar fusion with paired pedicle screws at the L4 and L5.T10/11: Mild disc bulge and left ligamentum flavum thickening without significant associated stenosis.T11/12: Mild disc bulge, mild bilateral facet hypertrophy, and ligamentum flavum thickening, without significant associated stenosis.T12/L1: There is a tiny central disc protrusion, mild disc bulge, mild bilateral facet hypertrophy, and ligamentum flavum thickening. There are no significant stenoses.L1/2: Mild facet hypertrophy and ligamentum flavum thickening without significant associated stenosis.L2/3: Mild disc bulge, facet hypertrophy, and ligamentum flavum thickening, without significant associated stenosis.L3/4: Grade 1 anterolisthesis L3 on L4, diffuse annular disc bulge, ligamentum flavum thickening, and facet hypertrophy (partially obscured by metallic artifact). There is mild left neural foraminal and mild to moderate right neural foraminal stenosis.L4/5: Grade 1 anterolisthesis L4 on L5, diffuse annular disc bulge with left paracentral disc irregularity containing T2 hyperintense signal which may be postprocedural, ligamentum flavum thickening, and bilateral facet hypertrophy (partially obscured by metallic artifact). There is mild to moderate bilateral neural foraminal stenosis.L5/S1: Asymmetric bulge to the left, mild left facet hypertrophy, moderate right facet hypertrophy, and 4 mm synovial cyst off the posterior aspect of the right facet complex. There is moderate left neural foraminal and mild to moderate right neural foraminal stenosis. | 1.T12/L1: There is a tiny central disc protrusion without stenosis.2.L3/4: Grade 1 anterolisthesis L3 on L4; mild left neural foraminal and mild to moderate right neural foraminal stenosis.3.L4/5: Grade 1 anterolisthesis L4 on L5; mild to moderate bilateral neural foraminal stenosis.4.L5/S1: Moderate left neural foraminal and mild to moderate right neural foraminal stenosis. |
Generate impression based on findings. | 2-year-old male status post PICC placementVIEW: Chest AP (one view) 2/19/15 17:39 Left PICC tip withdrawn to the SVC. Enteric tube tip and side-port in the stomach. ETT above the carina. The cardiothymic silhouette is normal.Interval improvement in right upper lobe and retrocardiac atelectasis. | PICC tip withdrawn to SVC. |
Generate impression based on findings. | AML, pneumonia. Assess for interval change of pneumonia now on antibiotics. LUNGS AND PLEURA: New small bilateral pleural effusions, greater on the left, with adjacent atelectasis.Significantly increased size of left upper lobe consolidation with adjacent ill-defined groundglass opacity, consistent with infection.The small nodular opacity in the right middle lobe, likely also infection, is not significantly changed accounting for motion artifact.Calcified right lower lobe lung nodule.MEDIASTINUM AND HILA: Moderately enlarged right paratracheal mediastinal lymph nodes, unchanged. Calcified right hilar and mediastinal nodes consistent with healed granulomatous disease.Severe coronary artery calcification.Normal heart size without pericardial effusion.Right PICC tip is in the SVC.CHEST WALL: No axillary lymphadenopathy.Mild to moderate degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Splenic and hepatic calcified granulomas. | 1. Significant increased size of left upper lobe consolidation with adjacent groundglass opacity, consistent with pneumonia, nonspecific in etiology but Legionella and Klebsiella are included in the differential.2. New bilateral small pleural effusions, greater on the left. |
Generate impression based on findings. | 10 week old female with left upper lobe and lingular atelectasis.VIEW: Chest AP (one view) 2/20/2015 at 0557 There has been interval improvement in previously seen left upper lobe and lingular atelectasis. No new focal opacities or pleural effusions. Normal cardiothymic silhouette. | Interval improvement in left upper lobe and lingular atelectasis. |
Generate impression based on findings. | 10-week-old female with hypoxia and tachypnea.VIEW: Chest AP (one view) 2/19/2015 at 1908 Left upper lobe and lingular opacities likely represent atelectasis. No pleural effusion or pneumothorax. Left sided cardiac apex and stomach. | Left upper lobe and lingular atelectasis. |
Generate impression based on findings. | T3N2cM0 squamous cell carcinoma of the left soft palate and tonsil status post cycle 7/7 of FHX completed on 9/12/14. There are post-treatment findings in the neck. There is no evidence of mass or abnormal enhancement within the area of the left tonsil. There is no cervical lymphadenopathy by size criteria. The salivary glands and thyroid glands appear unchanged. The vasculature structures in the neck are intact. There is supraglottic mucosal edema, but the airway is patent. The osseous structures are unchanged. There is a mild amount of deep and fluid within the left maxillary sinus. There is opacification of bilateral mastoid air cells. The imaged intracranial structures and orbits are unremarkable. A 3-mm left upper lobe pulmonary nodule has been stable since 10/17/14. There are mild emphysematous changes at bilateral apices. | 1. No evidence of measurable mass lesion in the area of the treated left tonsil to suggest recurrence tumor. 2. No significant cervical lymphadenopathy by size criteria.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
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, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is extremely dense, limiting the sensitivity of mammography and increasing the importance of physical examination, 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, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSD - Screening Mammogram. |
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