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Generate impression based on findings. | Seven week old male with a history of left UPJ obstruction status post left pyeloplasty. BLADDER Wall Thickness: Normal Contents: 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: 1 Left: 3 Length*** Right: 6.0 cm Left: 7.1 cm Mean for age: 4.5 cm Range for age: 4 - 5.5 cmADDITIONAL OBSERVATIONS: No perinephric fluid collections. | Grade 3 left hydronephrosis and grade 1 right 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. | 13-year-old female, evaluate for gastric outlet obstructionVIEW: Abdomen AP (one view) 2/20/15 9:53 Contrast is noted in the ascending and transverse colon from recent esophagram, precluding a diagnostic upper GI exam from being performed. The bowel gas pattern is nonobstructive. | Contrast in the colon from recent esophagram. Upper GI exam will be deferred until this contrast clears. |
Generate impression based on findings. | 58 year-old female with a history of carcinoid and chronic diarrhea. Patient was unable to tolerate the full prescribed amount of oral contrast. The small bowel is suboptimally distended which somewhat limits evaluation.ABDOMEN:LUNG BASES: Calcified nodule in the right lower lobe likely from prior granulomatous disease. Mild basilar atelectasis.LIVER, BILIARY TRACT: There are several punctate arterially enhancing lesions in hepatic segments 6 and 7 which are isointense on the portal venous phase. An example lesion in hepatic segment 6 (series 9, image 50) measures 0.5 x 0.5 cm. Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Tiny left adrenal nodule measures less than 10 HU on the noncontrast images and thus is compatible with a benign adenoma.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Mild atherosclerotic disease of the abdominal aorta and its branches.BOWEL, MESENTERY: Postsurgical changes from prior right hemicolectomy. Ileocolonic anastomosis is noted in the midline. The proximal small bowel loops are suboptimally distended. The small bowel is of normal caliber without evidence of obstruction. No abnormal small bowel wall thickening or small bowel lesions are identified.An average amount of stool is present within the remaining distal colon without evidence of focal lesion. An enlarged nonspecific mesenteric lymph node (series 11, image 81) measures 0.7 x 1.4 cm. BONES, SOFT TISSUES: Postsurgical changes to the anterior abdominal wall without evidence of complication. Degenerative changes of the visualized thoracolumbar spine. Spinal fusion hardware at L4-L5. Foci of gas within the anterior abdominal wall likely related to injection.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of the visualized thoracolumbar spine. Spinal fusion hardware at L4-L5. There is a nonspecific sclerotic focus within the right ilium adjacent to the SI joint (series 3, image 96). Nonspecific focus of subcutaneous soft tissue attenuation in the right gluteal soft tissues (series 11, image 95). | 1.Postsurgical changes of right hemicolectomy.2.Several punctate hepatic segment 7/6 hypervascular lesions are nonspecific but given history of carcinoid may represent carcinoid metastases. Recommend MRI for further evaluation. 3.Evaluation of small bowel mildly limited by suboptimal distention of the proximal small bowel. Within this limitation, no abnormalities identified in the small bowel.4.Nonspecific sclerotic focus within the right ilium adjacent to the SI joint, correlate with procedural history. |
Generate impression based on findings. | Four-year-old male with right femoral fracture status post orthopedic fixation.VIEWS: Right femur AP and lateral (two views) 2/20/2015 at 1036 Evaluation of bony detail is limited by overlying casting material. Oblique fracture of the mid femoral diaphysis is in near-anatomic alignment status post orthopedic fixation with plate and screw device. Increased sclerosis about the fracture line is indicative of interval healing. No evidence of hardware complication or loosening. | Healing mid femoral fracture as described above. |
Generate impression based on findings. | 65 years, Male, Reason: recommended f/u imaging for US significant for "Questionable right lower pole complex mass lesion versus partial duplication" History: as above. CHEST:LUNGS AND PLEURA: Left basilar subsegmental atelectasis. Scattered nonspecific micronodules. No suspicious nodule.MEDIASTINUM AND HILA: Trace pericardial effusion.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Lipoma within the uncinate.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Heterogeneous well-circumscribed mass in the right mid to upper pole which is of higher than fluid attenuation and measures 6.1 x 5.8 cm. Subcentimeter lesion in the right lower pole (3/127) was not seen on prior ultrasound and is of higher than fluid attenuation and indeterminate. Subtle right upper pole hypodensity measuring fluid attenuation likely represents a cyst but is incompletely characterized. Left parapelvic cyst seen on prior ultrasound.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcifications of the aorta and its branches. Mild bilateral perinephric stranding.BOWEL, MESENTERY: No significant abnormality noted.PELVIS: PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative changes of the visualized spine. | 1.Well-circumscribed heterogeneous mass in the right kidney, appearance suspicious for primary renal neoplasm. Recommend contrast enhanced MRI or CT for further evaluation.2.Additional subcentimeter right lower pole lesion of higher than fluid attenuation is incompletely characterized. |
Generate impression based on findings. | Reason: R/o sinusitis History: R facial pain, fever The ostiomeatal complex units are patent bilaterally. Within the nasal cavity no obstructive lesions are appreciated. There is partially opacified right-sided concha bullosa present. The nasal septum is deviated towards the left side and there is an osteophyte off the nasal septum which extends towards the left inferior concha.There is a right sided Haller cell presentThe frontal sinuses demonstrate some scattered opacities in the right frontal sinusMaxillary sinuses demonstrate heterogeneous opacification of the inferior aspect of the right maxillary sinus and some mucosal thickening along the inferior aspect of the left maxillary sinus.Ethmoid air cells demonstrate some minor opacities along the right anterior ethmoid air cellsSphenoid sinuses are clear. Visualized portions of the mastoid air cells and middle ears are clear. Visualized orbits are intact and the visualized intracranial structures are within normal limits. There is an old left-sided medial blowout fracture present.No osseous erosion is appreciated.Atherosclerotic calcifications are present along the distal internal carotid arteries. | 1.There are scattered opacities present in the right frontal sinus, anterior ethmoid air cells and right maxillary sinus with inspissated secretions which suggests obstruction at the right hiatus semilunaris. Of note there is a Haller cell in this region. |
Generate impression based on findings. | 61 year old man with chest pain. He is referred to exclude obstructive coronary disease. Patient was referred as part of a clinical study.CPT Code: 75574 Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There are no significant stenoses present in the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There are no significant stenoses in the LAD. LCx: The left circumflex coronary artery is dominant. It courses normally in the left AV groove. It gives rise to the PDA, PL, and obtuse marginal branches. There are no significant stenoses in the LCx. There is mild, non-obstructive (<10% stenosis) atherosclerosis in the proximal vessel. The remainder of the LCx and its branches are free of disease. RCA: The right coronary artery is small and arises normally from the right sinus of Valsalva. It is a non-dominant coronary artery. There are no significant stenoses in the right coronary artery.Left Ventricle: The left ventricular late diastolic volume is normal. There is normal wall thickness. Right Ventricle: The right ventricle is moderately dilated. Left Atrium: Visually, the left atrial volume appears to be normal in size. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume appears to be mildly dilated. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not seen. The main pulmonary artery is mildly dilated.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion. | 1. There are no significant coronary artery stenoses present. 2. There is minimal coronary atherosclerosis. 3. Moderate RV dilation with mild RA and main pulmonary artery dilation. This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report. |
Generate impression based on findings. | 15-year-old male with history of trauma to 4th digit two weeks ago. VIEWS: Left hand PA, left fourth finger oblique and lateral (3 views) 2/20/2015 at 1103 There is a faint lucency through the dorsal epiphysis of the 4th middle phalanx adjacent to the PIP joint. Minimal sclerosis is noted about this fracture line. Mild residual soft tissue swelling is noted about the 4th PIP joint. | Healing Salter Harris 3 fracture of the fourth middle phalanx as described above. |
Generate impression based on findings. | Reason: h/o left carcinoma ex-pleomorphic adenoma History: r/o lung mets LUNGS AND PLEURA: Scattered punctate benign appearing micronodules without evidence of pulmonary or pleural metastases.Stable foci of linear scarring.MEDIASTINUM AND HILA: Unchanged upper normal sized left paratracheal lymph node, likely benign given its morphology. All other mediastinal lymph nodes are not significantly enlarged.Visible coronary calcification, the right side pericardial cyst is unchanged, and the heart otherwise appears normal. CHEST WALL: Healed right rib fracture, otherwise unremarkable.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Status post splenectomy. | No sign of metastases, or other significant abnormality. While several mediastinal lymph nodes are visible, they are not abnormally enlarged. |
Generate impression based on findings. | Known type B aortic dissection being medically managed now with SOB and hemoglobin drop. Evaluate for hemothorax or other bleeding. LUNGS AND PLEURA: Mild centrilobular emphysema.Lobular areas of groundglass opacity diffusely, greater on the right, increased from prior exam. This is suspicious for pulmonary hemorrhage, other possibility is aspirated fluid.No pleural effusion or hemothorax.MEDIASTINUM AND HILA: Known type B aortic dissection originating distal to the left subclavian artery and extending distally into the descending thoracic aorta, not significantly changed within limitations of noncontrast exam. Caliber of the aorta is similar to prior and there is no evidence of rupture.Severe coronary artery calcification.Moderate cardiomegaly and post-surgical findings of CABG. Pacemaker leads, unchanged in position.Mildly enlarged mediastinal lymph nodes, unchanged.CHEST WALL: Median sternotomy.Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Stable hepatic cyst. Abdominal aorta atherosclerotic calcification. Right upper pole renal cyst, incompletely imaged. | 1. Type B aortic dissection without significant change in aorta caliber or evidence of rupture.2. No hemothorax as clinically questioned. 3. Increased bilateral groundglass opacities suspicious for pulmonary hemorrhage or aspirated blood given history; alternative possibility would be other types of aspirated fluid. |
Generate impression based on findings. | Ms. Barnes is a 77 year old female with a personal history of left breast mastectomy in the 1970s for breast cancer. Personal history of stable right breast mass for 60 years corresponding to a known fibroadenoma. Family history of ovarian cancer in her mother. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Scattered benign calcifications, including coarse popcorn-like calcifications from a hyalinized fibroadenoma in the central right breast, are stable. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast. | Stable hyalinized fibroadenoma in the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Ms. Alitto is a 75 year old female with a personal history of right breast lumpectomy in 1997 for cancer followed by radiation, chemotherapy, and tamoxifen therapy. She has no current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the right breast. There are stable postsurgical changes including architectural distortion, increased density, and benign dystrophic calcifications present within the right lumpectomy site. Additional scattered benign calcifications are seen in both breasts. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. Several stable benign intramammary lymph nodes are identified in the left upper outer breast. | Stable postsurgical changes of the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Again seen are postsurgical changes of next dissection including resection of inferior right level 5 mass. There is interval decrease in previously seen residual lesion with no discrete measurable mass apparent on the current study. There is ill-defined soft tissue which may represent scar. Multiple surgical clips are seen in the surgical bed. No significant cervical lymphadenopathy.There are stable postoperative findings in the region of the oropharynx. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. Left chest wall port. The osseous structures are unchanged including moderate degenerative changes and at least moderate spinal canal stenosis at C5-6 . The airways are patent. The imaged intracranial structures are unremarkable. Again seen are emphysematous changes in the lungs and right upper lobe lung nodule. Please refer to dedicated CT chest for further details. | Continued evolution of postsurgical changes of right inferior level 5 neck dissection and tumor resection. There is interval decrease in previously seen residual lesion with no discrete measurable mass apparent on the current study. There is ill-defined soft tissue in the surgical bed which may represent scar. No recurrent mass in the oropharynx. No significant cervical adenopathy. |
Generate impression based on findings. | Male, 56 years old, history of T2 N2b base of tongue cancer. Head:No mass effect, focal edema or suspicious enhancement is seen to suggest brain parenchymal metastatic disease. The bones of the calvarium and skull base are intact. Neck:The aerodigestive mucosa is unremarkable with no evidence suggesting recurrent tumor. No pathologic adenopathy is detected by size criteria. The salivary glands are normal. The cervical vessels enhance as expected. A small right posterior tracheal diverticulum is redemonstrated. No concerning osseous lesions are seen. | 1. No evidence of local disease recurrence or pathologic adenopathy is seen.2. No intracranial metastases. |
Generate impression based on findings. | 14 year old male with recent diagnosis of SMA syndrome. Limited double contrast visualization of the esophagus showed no large morphologic abnormalities of the mucosal surfaces or mural contours. The stomach was significantly enlarged in size with a J-shape extending inferior to the pelvis. In the right side down lateral decubitus position, spontaneous emptying of contrast into a dilated first, second and proximal third portion of the duodenum was noted with an abrupt cutoff near midline. At this time, the patient complained of abdominal discomfort. To-and-fro movement was noted within the duodenum as demonstrated on series 13. With the patient rolling, contrast passed into the distal third and fourth portion of the duodenum. Normal appearance and peristalsis of the proximal jejunum was noted. TOTAL FLUOROSCOPY TIME: 5:17 minutes | 1.Findings compatible with patients diagnosis of SMA syndrome. 2.Significantly enlarged stomach suggestive of chronic gastric outlet obstruction. |
Generate impression based on findings. | Male 54 years old; Reason: History of AML, s/p stem cell transplant patient with progressive ascending LE weakness. Weakness at level of diaphragm. Diffuse infiltrative process seen on recent CT. History: LE weakness, numbness, heaviness, sensation changes, ataxia, dysmetria, hyperreflexia.RADIOPHARMACEUTICAL: 11.6 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 77 mg/dL. Today's CT portion grossly demonstrates mild residual stranding in the retroperitoneum which is more prominent in the left pelvis.Today's PET examination demonstrates no FDG avid activity to indicate tumor. There is minimal activity in the retroperitoneum which indicates inflammatory change. | 1.No FDG avid activity to indicate tumor.2.Minimal stranding and activity in the retroperitoneum indicates residual inflammatory process. |
Generate impression based on findings. | PMH of ectopic atrial beats presents with palpitations. Question of PE. The comparison chest radiograph performed on 2/20/2015 demonstrates no focal pulmonary opacities or pleural fluid. The ventilation images show a uniform distribution of activity on single-breath and wash-in images. There is abnormal Xe-133 retention in the bilateral lower lobes during the wash-out phase. The perfusion images demonstrate medium to large matched perfusion defects of the right and left lower lobes. No medium or large unmatched perfusion defects are identified. | Low probability for pulmonary embolus. |
Generate impression based on findings. | DesaturationVIEW: Chest AP Tracheostomy tube in place. NG tube tip in the stomach. Cardiothymic silhouette cannot be evaluated. Near complete collapse of the right lung with atelectasis new from prior study. Patchy atelectasis left lower lobe. | Near complete collapse of the right lung with atelectasis new from prior study. |
Generate impression based on findings. | FractureVIEWS: Left clavicle AP and axial Healing fracture involving the distal left clavicle with bony remodeling. The alignment is near anatomic. | Healing left clavicular fracture as described above. |
Generate impression based on findings. | 57 year old male with history of pancreatic cancer s/p duodenal stent placement with symptoms of obstruction. Scout image demonstrates a duodenal stent in the first and second portion of the duodenum. Water soluble contrast swallow demonstrated spontaneous emptying into the duodenum. There is narrowing of the second portion of the duodenum with maximum distention measuring at 6 mm. TOTAL FLUOROSCOPY TIME: 3:01 minutes | Narrowing of the lumen at the second portion of the duodenum measuring up to 6 mm in maximum distention. |
Generate impression based on findings. | Female 38 years old Reason: 38F s/p ex lap for metastatic colon cancer with ileus vs obstruction History: N/V ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No focal liver lesions. Cholelithiasis. No biliary dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is marked dilatation of the jejunum and massive dilatation of ileum measuring about 4.6 cm in average diameter. The transition zone is seen at the pelvic inlet near the sutures in the left lower quadrant. This is concerning for mechanical obstruction. No intramural or free air. There is a small amount of free intraperitoneal fluid.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXAE: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Transition zone seen in the left lower quadrant near the sutures with several collapsed loops of distal ileum seen in the dependent portion of the pelvis right lower quadrant. These findings are concerning for mechanical obstruction.BONES, SOFT TISSUES: Postsurgical changes anterior abdominal wound with skin staples and some fluid seen throughout the surgical wound consistent with recent surgery. Small amount of gas seen in the surgical wound as well spaced image 98.OTHER: No significant abnormality noted | Concern for high grade mechanical obstruction near the anastomosis in the left lower quadrant. Small amount of intraperitoneal fluid may be postoperative in nature or related to obstruction.Cholelithiasis. Findings discussed with Dr. Martin Coronel pager 3163. |
Generate impression based on findings. | CVA, muscle weakness. 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 demonstrate a minor opacity in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction. |
Generate impression based on findings. | Male 59 years old; Reason: esophageal cancer, monitoring History: cachectic CHEST: Interval improvement in previously seen thin walled cavity in the right lower lobe. Biapical bleb formation and centrilobular emphysema.LUNGS AND PLEURA: Improved aeration in right upper lobe. Sequela of aspiration, including small debris/secretions in mid to distal trachea. Improved right pleural fluid. Bibasilar atelectasis/scarring.MEDIASTINUM AND HILA: Mediastinal shift towards right, likely related to underlying atelectasis/volume loss. Trace pericardial effusion. Severe calcified coronary artery disease. Esophagogastric stent in place traversing lobulated esophagogastric mass (wall thickening involving proximal gastric body/cardia visualized) which, accounting for differences in technique, is without significant change in size and measures approximately 5.6 x 3.4 cm, image 67 series 3. Contrast seen outlining mass. Again seen is significant amount of intraluminal debris in esophagus.CHEST WALL: No significant abnormality noted.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: Symmetric renal parenchymal enhancement. Areas of right-sided renocortical scarring, stable. 3 mm left-sided nonobstructing calculus.RETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: Esophagogastric stent in place traversing lobulated esophagogastric mass which, accounting for differences in technique, is without significant change in size and measures approximately 5.6 x 3.4 cm, image 67 series 3. Contrast seen outlining mass. Again seen is significant amount of intraluminal debris in esophagus. Percutaneous gastrojejunal tube. Tip of enteric tube seen beyond ligament of Treitz, in small bowel in left lower quadrant.PELVIS:PROSTATE, SEMINAL VESICLES: Intraprostatic calcification.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Visualized osseous structures stable in appearance. Healing rib fractures seen. Decreased osseous mineralization. Right upper paraspinal lipoma. | 1. Interval improvement in right lower lobe cavitary lesion and improved aeration as described.2. Accounting for differences in technique, no significant change in stented gastroesophageal mass. |
Generate impression based on findings. | Male 64 years old; Reason: bladder stones, prostate cancer History: bladder stones The exam is not sensitive detecting lesions in the bowel to the lack of oral contrast in the solid organs and vasculature due to the lack of intravenous contrast. Given those limitations, the following observations are made:ABDOMEN:LUNGS BASES: Calcific granuloma left lower lobe. Minimal scarring.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: Hypodensities in the kidneys present renal cysts better seen on the prior contrast enhanced exam. Parapelvic cysts left kidney and right kidney. Some cortical cysts on the left. No hydronephrosis single punctate calcification in the right lower pole series 2 image 70. No other foci of nephrolithiasis. No nephrolithiasis seen along the course of the ureters.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE/SEMINAL VESICLES: Mildly enlarged prostate with particularly prominent median lobe.BLADDER: A few small calcifications are seen in the midline in the urinary bladder. The overall stone burden the bladder is decreased compared to the 1/16/14 study where numerous additional calcifications were seen. LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Scattered diverticulosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Mild atherosclerotic calcifications right common iliac artery. | 1.Single punctate focus of nephrolithiasis right lower pole. Presumed renal cysts bilaterally. No hydronephrosis. 2.A few bladder calculi, but decreased compared to the prior exam. |
Generate impression based on findings. | Follow-up Evaluation of the hindfoot is limited by an overlying external fixation device. The patient has presumably undergone resection of the distal fibula and medial malleolus. The distal fibular osteotomy margin is better defined on the current study than the prior study, suggesting healing. The medial malleolar margin is also better defined on the current study, with adjacent heterotopic ossification, suggesting healing. There is severe uniform narrowing of the tibiotalar joint. There is mild soft tissue swelling particularly along the lateral aspect the ankle. Overall, the bones appear demineralized. Severe osteoarthritis affects the talonavicular joint. Arterial calcifications are noted in the soft tissues. | Postoperative changes and osteoarthritis as described above. |
Generate impression based on findings. | Medial knee pain Four views of the left knee are provided. Moderate osteoarthritis affects the patellofemoral joint, with a prominent subchondral cyst seen in the medial facet of the patella. Mild osteoarthritis affects the tibiofemoral compartments.Similar osteoarthritic changes affect the right knee as seen on the frontal views. | Osteoarthritis. |
Generate impression based on findings. | Pain, swelling, decreased range of motion at base of distal phalanx. Evaluate for fracture. There is a comminuted fracture of the distal phalanx involving the tuft and base of the phalanx; fracture fragments are in near-anatomic alignment. There is surrounding soft tissue swelling. | Third toe fracture as above. This was text paged to 4480 at the time of dictation. |
Generate impression based on findings. | Left lower extremity pain. Evaluate for lumbar spine pathology. Severe degenerative disk disease affects L5/S1. The remaining intervertebral disk spaces are relatively well-preserved. Vertebral body heights are maintained. Mild facet joint osteoarthritis affects the lower lumbar spine. Alignment is within normal limits. A left hip arthroplasty device is incompletely imaged on this study. There is a surgical clip in the left hemiabdomen. There is calcification of the aorta and common iliac arteries. | Degenerative disk disease and other findings as above. |
Generate impression based on findings. | Male 72 years old ; Surgical Case Information | Procedure(s): Procedure(s) with comments: | LAPAROSCOPIC /THORACOSCOPIC ESOPHAGECTOMY W/ THORACIC ANASTOMOSIS | LAPAROSCOPIC JEJUNOSTOMY TUBE PLACEMENT | OPEN ESOPHAGECTOMY WITH THORACOTOMY | JEJUNOSTOMY TUBE PLACEMENT | IVC FILTER - Procedure performed: IVC Filter Placement and Triple Lumen Placement. | Operating Room: CDOR 18 CENTRAL | Surgeon(s) and Role: | Panel 1: | * Marco G. Patti, M.D. - Primary | * Irma Dekonti Fleming, M.D. | Panel 2: | * Wickii T. Vigneswaran, M.D. - Primary | * Trevor M. Williams, M.D. | Panel 3: | * Christopher L. Skelly, M.D. - Primary | * Sara Amelia Gaines, M.D. | Multiple clips are noted in the left upper abdomen. A catheter type device projects over the left upper abdomen.IVC filter projects over the L2 vertebral body.Radiopaque objects over the upper abdomen might represent towels external to the abdominal cavity. There is some free intraperitoneal air in the left upper abdomen. No unexpected radiopaque foreign body is evident. | No unexpected radiopaque foreign body.These findings were discussed by telephone with Dr. Patti, the attending surgeon, on 2/20/2015 at 12:30 p.m.. |
Generate impression based on findings. | Reason: intracranial hemorrhage? History: altered mental status 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 acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction. |
Generate impression based on findings. | Right knee pain Four views of the right knee are provided. There is mild narrowing of the medial tibiofemoral compartment and tiny patellar osteophytes indicating minimal osteoarthritis. Poorly defined mineralization along the medial facet of the patella likely simply represent additional osteophyte formation; however if there is a recent history of patellar dislocation then the possibility of a nondisplaced fracture is considered, albeit less likely. There is a small joint effusion.Mild osteoarthritis affects the left knee as seen on the frontal views. | Osteophytes and other findings as described above. If there is clinical concern for fracture or soft tissue derangement of the knee, then MRI may be considered. |
Generate impression based on findings. | Female, 67 years old, history of supraglottic cancer, radiotherapy follow-up examination. Treatment related findings are seen including infiltration of the fascial planes and supraglottic mucosal edema. No evidence of any mucosal space mass lesion is seen.No pathologic adenopathy in the neck by size criteria. The salivary glands and thyroid are free of focal lesions. The left IJ vein is of small caliber but seems to opacify. Predominantly non-calcified atherosclerotic disease affects the distal common carotid arteries, particularly on the left where there is at least a 60% stenosis. The right vertebral artery is small and shows somewhat thready contrast opacification. Emphysema is evident in the lung apices. Extensive cervical spondylosis is seen with loss of disk height and disk osteophyte formation from C3 through C7 similar to prior. There are mild to moderate stenoses at these levels. | Treatment related findings with no evidence of mucosal tumor or pathologic adenopathy. |
Generate impression based on findings. | Right knee pain and swelling. Assess degree of osteoarthritis. Four views of the right knee are provided. Small osteophytes indicate mild osteoarthritis. There is a small joint effusion.Mild osteoarthritis affects the left knee as seen on the frontal view. | Mild osteoarthritis. |
Generate impression based on findings. | 65 years old male. Reason: primary origin of metastatic squamous cell carcinoma. History: squamous cell carcinoma of the skin suggestive of internal malignancy. RADIOPHARMACEUTICAL: 9.2 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 103 mg/dL. Today's CT portion grossly demonstrates curvilinear densities in the left lower lobe of the lung. Multiple diverticula are noted in the colon. The prostate is enlarged.Today's PET examination demonstrates focal area increased activity in the right lower quadrant of the abdomen with SUV Max of 6.5. The focal abnormal FDG uptake correlates with an apparent wall thickening/soft tissue mass in the cecum.There is no abnormal FDG uptake in in the forehead or in the neck to suggest FDG avid tumor in these regions. There is no abnormal FDG uptake in the lymph nodes in the pelvis or retroperitoneal cavity. There is no other FDG avid lesion to suggest distant metastasis.FDG uptake in the remaining portion of the body is physiological. Physiological activity is seen in the liver, spleen, kidneys, ureters, bladder and testicles. Large area of activity is noted in the right upper arm, which is likely due to infiltration of the tracer during the FDG injection. | 1.Focal abnormal FDG uptake in the right lower quadrant of the abdomen, corresponding to an apparent wall thickening/mass seen in the cecum. The differential diagnoses including colon cancer, inflammatory change or normal variation. Suggest further evaluation with colonoscopy. No evidence of regional lymph node or distant metastasis.2.No evidence of FDG avid tumor in the head and neck regions.3.Multiple colonic diverticula and prostate enlargement seen on CT. |
Generate impression based on findings. | Reason: h/o met medullary thyroid cancer, compare to previous, measurements. CT neck:Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.There is a 13 x 14 mm left level 2 lymph node present which measured 16 x 16 mm on the prior exam. There is a 15 x 12 mm heterogeneous left level 3 lymph node present which measured 15 x 15 mm on the prior exam. There is a 16 x 21 mm axial dimension left level 4 lymph node present which previously measured 22 x 21 mm in axial dimensions small lymph nodes are present in the superior mediastinum. There is a right pretracheal lymph node present measuring 19 x 16 mm axial dimensions which previously measured similar dimensions compared a right level 4 lymph node currently measures 16 x 10 mm and previously measured 19 x 14 mm .Within the visceral space the left lobe of the thyroid gland has been surgically removed. Surgical clips are present in the left thyroid bed. The airway appears patent.The parotid and the submandibular glands appear intact.The visualized lung apices appear stable.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No acute 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.Lymphadenopathy in the neck has mildly regressed in size when compared to the December 2014 exam.2.Mediastinal adenopathy. Please refer to chest CT of the same date for additional information.3.No evidence for brain metastases. |
Generate impression based on findings. | Fracture The bones are demineralized suggesting osteopenia/osteoporosis. Again seen is a predominantly transverse impacted fracture of the distal radius with fracture fragments in near anatomic alignment. There has been maturation of callus along the fracture indicating some interval healing. There is a slight positive ulnar variance. There is an ununited ulnar styloid fracture fragment, unchanged. | Healing distal radius fracture as above. |
Generate impression based on findings. | 67-year-old with abscess on right base of big toe. Rule-out osteo-. There is swelling of the soft tissues along the medial and inferior aspects of the first metatarsophalangeal joint. Small foci of gas density within the swollen soft tissues plantar to the first MTP joint presumably represent the known abscess. I see no osteolysis to confirm osteomyelitis. | Findings compatible with the stated diagnosis of soft tissue abscess without radiographic evidence of osteomyelitis. If further imaging evaluation is clinically warranted, MRI may be considered. |
Generate impression based on findings. | There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are prominent but unchanged. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There are bilateral concha bullosa. The skull and extracranial soft tissues are unremarkable without soft tissue swelling. | No acute intracranial hemorrhage or skull fracture. |
Generate impression based on findings. | Metastatic lung cancer evaluate response to erlotinib. CHEST:LUNGS AND PLEURA: Nodule near in the left apex abutting the major fissure measures 4 x 9 mm, previously 6 x 9 mm (4/18). Left lower lobe paramediastinal opacities (4/37-45) are associated with adjacent focal pleural fluid and retraction, the pattern is suggestive of mild radiation fibrosis. Similarly, mild paramediastinal consolidation along the spine is seen on the right. No new suspicious nodules. No pleural fluid.MEDIASTINUM AND HILA: Small circumferential pericardial fluid collection only minimally increased in volume. The reference subaortic lymph node (previously erroneously described as a prevascular lymph node) measures 6-mm in short axis, previously 9 mm, the long axis is no longer measurable (3/29). No enlarged lymph nodes.CHEST WALL: Sclerotic skeletal metastases which are slightly expansile are without significant change. Expansile sclerotic left eighth rib metastasis measures 3.8 x 2.1 cm (3/77), previously 3.7 x 2.1 cm.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Unchanged skeletal metastases.OTHER: No significant abnormality noted. | Minimal increase in pericardial fluid volume which remains small. Skeletal metastases with the reference lesion measurement not significantly changed. Left apical nodule and mediastinal lymph node measure smaller. |
Generate impression based on findings. | Lumbar spine pain status post lower speed MVC. Fracture? There is perhaps a slight leftward curvature of the thoracolumbar spine, but alignment is otherwise within normal limits and I see no fracture. Tiny osteophytes project from the anterior aspects of the lumbar vertebrae. There is perhaps minimal degenerative disk disease at L2/3, but this is equivocal. Calcification in the pelvis may represent a uterine fibroid. | No fracture evident. Minimal degenerative changes and other findings as above. |
Generate impression based on findings. | Elbow pain There is a linear lucency seen on the external oblique view traversing the medial condyle which I suspect is artifactual, perhaps due to an overlying skinfold. I see no definite fracture, malalignment, or joint effusion. | No specific findings to account for the patient's elbow pain. If further imaging evaluation is clinically warranted, MRI may be considered. |
Generate impression based on findings. | Status post ORIF A plate and screw device affixes a fracture of the distal fibular diaphysis in near anatomic alignment. I see no hardware complications. A pin and screw affix a fracture of the medial malleolus in near anatomic alignment. The fracture line is less distinct on the current study than on the prior study, perhaps reflecting some interval healing. There is also a nondisplaced "posterior malleolus" fracture of the distal tibia; the fracture line is indistinct, suggesting some healing. There is mild diffuse soft tissue swelling. | Orthopedic fixation of distal fibular and tibial fractures as above. |
Generate impression based on findings. | Severe pain in right second toe. Rule out fracture. Evaluation of the second toe is limited as the PIP joint is held in flexion. Seen on the lateral view is a linear lucency traversing a dorsal osteophyte projecting from the base of the distal phalanx, suggesting a nondisplaced fracture. Severe osteoarthritis affects the DIP joint. | Findings suggestive of a nondisplaced fracture through an osteophyte projecting from the dorsal aspect of the base of the distal phalanx. This was text paged to Dr. Schwartz at the time of dictation. |
Generate impression based on findings. | Cervical spondylosis with myelopathy Again seen are postoperative changes of multilevel laminoplasty appearing similar to those seen on the prior study. Degenerative disk disease affecting the mid and lower cervical spine also appears similar to the prior study. | Postoperative changes of multilevel laminoplasty and degenerative disk disease appearing similar to the prior study. |
Generate impression based on findings. | Back pain There is a slight leftward curvature of the thoracolumbar spine. There is also a slight pelvic tilt with the superior border of the right iliac wing projecting approximately 8 mm above that of the left iliac wing. Severe degenerative disk disease affects L1/2, with relatively mild degenerative disk disease affecting the remaining lumbar levels. Vertebral body heights are preserved. I see no spondylolisthesis. Osteoarthritis affects the left hip. | Degenerative disk disease and other findings as above. |
Generate impression based on findings. | Lung cancer on chemotherapy. CHEST:LUNGS AND PLEURA: Thick walled necrotic nodule with internal air and fluid significantly increased in size compared to the prior study, 2.5 x 2.1 cm (5/34), previously 6 x 5-mm.The originally measured necrotic mass just below the level the fiducial markers at the left interlobar level measures 2.1 x 5.2 cm (4/45), this is now a trilobed lesion that extends above the level of the marker where it was measured on the last examination. On the prior study at the original reference level, the mass measured 2.5 x 3.1 cm (prior image 48, series 3).The anterior, inferior component (4/48) has peripheral enhancement and central necrosis, increased from the prior examination from 9 x 15 mm to 23 x 30 mm (4/48, nonindex measurement).Pleural thickening bilaterally emphysema and post therapeutic changes are seen bilaterally. MEDIASTINUM AND HILA: Left lower paratracheal lymph node measures 10 mm, previously 9 mm, not significantly changed (4/35). Mild the prominent mediastinal lymph nodes elsewhere are not significantly changed. Left hilar and interlobar lymph node enlargement not significantly changed. Moderate coronary artery calcification. Eccentric mural thrombus at the aortic arch unchanged. No pericardial fluid.CHEST WALL: Subcutaneous edema.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholecystectomy. SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Unchanged solid nodule in the right adrenal gland compared to most recent previous study, though it is new from earlier remote studies.KIDNEYS, URETERS: Complex cystic mass left kidney containing wall calcification measures 3.7 x 3.5 cm, slightly larger when comparing back to earlier studies, a second thick walled cystic lesion along the inferior pole of the left kidney (4/1 to two) has enlarged since the last examination and is now suspicious for a cystic metastasis. PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Lumbar spine fixation hardware. The spacing device between L3 and L4 vertebral bodies has migrated to the left of the spine, protruding beyond the margins of the vertebral column by approximately 2-cm.OTHER: The bladder is incompletely included within the scanning range but is noted to have wall thickening. | Interval increase in size of reference lesions, with suspicious lesions in the left kidney and right adrenal gland. The spacing device between L3 and L4 vertebral bodies has migrated to the left of the spine, protruding beyond the margins of the vertebral column by approximately 2-cm. |
Generate impression based on findings. | Pain in the left knee with pain posteriorly Four views of the left knee are provided. There is narrowing of the medial compartment and small tri-compartmental osteophytes indicating mild to moderate osteoarthritis.Moderate osteoarthritis affects the right knee as seen on the frontal view. | Osteoarthritis. |
Generate impression based on findings. | Cough feverVIEWS: Chest AP and lateral Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. Peribronchial wall thickening with subsegmental atelectasis in the right lower lobe and left lower lobe. No pleural effusion or pneumothorax. | Bronchiolitis or reactive airway disease. |
Generate impression based on findings. | 52-year-old male, evaluate transplant kidney mass. Within the limits of a non IV contrast enhanced examination which limits the ability to evaluate solid parenchymal organs and vascular structures, the following observations can be made: ABDOMEN:LUNG BASES: Mild coronary artery calcifications are present. Cardiomegaly. Trace pericardial and bilateral pleural effusions. LIVER, BILIARY TRACT: Hepatic calcifications likely from prior granulomatous disease.SPLEEN: Calcifications likely from prior granulomatous disease.PANCREAS: No significant abnormality notedADRENAL GLANDS: Mild nonspecific thickening of the left adrenal gland.KIDNEYS, URETERS: Bilateral atrophic kidneys compatible with chronic kidney disease with multiple bilateral low attenuation lesions, likely cysts. RETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic disease of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Coarse prostatic calcifications. BLADDER: The bladder is underdistended. BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Small amount of free fluid is present within the pelvis. A transplant kidney is located within the right iliac fossa. Severe hydronephrosis is present with associated cortical thinning. There is relatively high attenuation material within the renal pelvis extending into the ureter which could represent blood products or lobulated neoplasm. | Outside exam read:1.Severe hydronephrosis of transplant kidney in the right iliac fossa with associated cortical thinning.2.Dense material within the transplant kidney collecting system and ureter may represent blood products or neoplasm. Correlation with patient's clinical history for any recent intervention recommended and f/u imaging to assess for resolution/interval change or dedicated contrast enhanced imaging recommended to exclude urothelial neoplasm. |
Generate impression based on findings. | 15-year-old male with respiratory distress, rule out pneumoniaVIEW: Chest AP (one view) 2/20/15 1:11 Severe scoliosis appears similar to the prior exam. The cardiothymic silhouette is unchanged. Right middle and lower lobe atelectasis without evidence of pneumonia or pleural effusions. | No evidence of pneumonia. |
Generate impression based on findings. | Retained food/bezor on EGD. RUQ pain. Visually there was significant and progressive gastric emptying. Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:30 mins: 71 % of peak activity (normal >70 %)1 hour: 58 % of peak activity (normal 30-90 %) 2 hours: 49 % of peak activity (normal <60 %) 4 hours: 2 % of peak activity (normal <10 %) | Gastric emptying within normal limits. |
Generate impression based on findings. | Pain, limping. Left total hip replacement November 2014. Four views of the right knee are provided. There is mild medial compartment narrowing and small tricompartmental osteophytes indicating mild to moderate osteoarthritis. I see no joint effusion.Mild osteoarthritis affects the left knee as seen on the frontal view. | Osteoarthritis. |
Generate impression based on findings. | Cough feverVIEWS: Chest AP and lateral Cardiothymic silhouette normal. Minimal peribronchial wall thickening with subsegmental atelectasis in the left lower lobe. No pleural effusion or pneumothorax. | Bronchiolitis or reactive airway disease. |
Generate impression based on findings. | Six months postop Again seen is a posterior stabilization device with screws entering L4, S1, and both iliac wings. Also again seen are spacer devices at L4/5 and L5/S1 with screws entering L5 and S1 anteriorly. A small amount of cement is again seen within the L4 vertebral body. Overall, these findings are similar to those seen on the prior study. Again noted is a levoscoliosis of the lumbar spine and severe degenerative disk disease at L2/3 as well as moderate degenerative disk disease at L1/2. Lumbar vertebral body heights are preserved. Severe degenerative disease affects the lower thoracic spine, particularly at T9/10. Bilateral total hip arthroplasty devices are incompletely imaged on this study. The bones appear demineralized. | Postoperative and degenerative changes appearing similar to those seen on the prior study. |
Generate impression based on findings. | 9-year-old male with desaturationVIEW: Chest AP (one view) 2/20/15 13:04 Interval placement of left pleural catheter with tip directed medially. Right pleural catheters are unchanged in position. ETT is above the carina. Left central venous catheter tip extends to cavoatrial junction.New moderate to large right pneumothorax with subpulmonic extension. Marked interval decrease in left pleural effusion. | Moderate to large right pneumothorax. Interval decrease in left pleural effusion. |
Generate impression based on findings. | Patient with metastatic lung cancer with bone metastases. There are multiple new osseous lesions involving the ribs, thoracic and lumbar spine, pelvis, distal right femur, and distal right tibia. There is also worsening and increased uptake of several calvarial, a left scapular, a left 7th rib, a proximal right tibial, and a distal left tibial lesion. | Progression of osseous metastatic disease. |
Generate impression based on findings. | UC evaluate toxic megacolonVIEW: Abdomen AP Disorganized nonobstructive bowel gas pattern. There is no abnormal bowel dilation. No pneumatosis or pneumoperitoneum. An IUD device is present in the lower pelvis new from prior study. | Normal examination. |
Generate impression based on findings. | Male 58 years old Reason: septic shock, possible sources aspiration PNA, parapneumonic effusion, peri-pancreatic fluid collection, recent diarrhea History: acute on chronic alcoholic pancreatitis, severe alcohol withdrawal Exam is suboptimal secondary to motion artifact. Limited study due to absence of intravenous contrast making evaluation of visceral and vascular pathology suboptimal.CHEST:LUNGS AND PLEURA: Moderate bilateral pleural effusions, left greater than right. The pleural effusions have increased in size compared to study from 2/17/2015.MEDIASTINUM AND HILA: Heart size at the upper limit of normal without pericardial effusion. Severe coronary artery calcifications. No mediastinal hilar lymphadenopathy.Patulous contrast-filled esophagus with contrast to the level of thoracic inlet.Right IJ venous catheter with tip in SVC. Endotracheal tube appropriately placed. Enteric tube tip in the duodenum. CHEST WALL: Degenerative changes of the thoracic spine.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: The spleen is displaced medially by a large, loculated low-density fluid collection measuring 12.0 x 10.0 cm (series 3, image 80). The fluid collection is similar in size to study from 2/17/2015.PANCREAS: Significant mass effect on the pancreas from adjacent low density fluid collection along the anterior aspect.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcifications of the abdominal aorta.BOWEL, MESENTERY: Significant mass effect and compression with anterior displacement of the stomach by a large peripancreatic loculated fluid collection measuring 13.5 x 11.7 cm (series 3, image 116). The fluid collection is similar in size to study from 2/17/2015. There is global small bowel and colonic wall thickening with more severe thickening in a segment of proximal jejunum approximately 15 cm in length best seen on coronal images (series 80264, image 62). Collapsed, largely gasless colon. BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Collapsed bladder with Foley catheter in place.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Moderate amount of free fluid within the pelvisBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Global small bowel and colonic wall thickening with severe wall thickening of a segment of proximal jejunum. Bowel ischemia cannot be excluded. 2.Large peripancreatic and perisplenic loculated low-density fluid collections causing significant compression of the stomach and likely secondary to patient's known pancreatitis. The fluid collections are similar in size to recent study from 2/17/2015.3.Moderate bilateral pleural effusions, which are slightly increased in size. Findings were discussed by telephone with the clinical service, Dr. Reid, at 2:30 p.m.. on 2/20/2015. |
Generate impression based on findings. | History of rheumatoid arthritis. Patient is participating in research study. Evaluate for lung disease. LUNGS AND PLEURA: Calcified nodules consistent with healed granulomatous disease.Scattered noncalcified micronodules are most likely also post-inflammatory.No evidence of interstitial lung disease.Mild bronchial wall thickening.No pleural effusion.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Normal heart size without pericardial effusion. No visible coronary artery calcification.Low-density blood pool consistent with anemia.Punctate nonspecific hypodense thyroid nodules.CHEST WALL: Midline abdominal surgical sutures.Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. 1 cm fat density hepatic dome lesion with a coarse calcification (series 3, image 72), likely a benign lesion such as a lipoma or angiomyolipoma (given patient does not have a history of a primary liposarcoma elsewhere).Post-surgical finding of gastric bypass. | No evidence of interstitial lung disease. Mild bronchial wall thickening. 1 cm fat-containing hepatic lesion, which is likely benign. |
Generate impression based on findings. | Status post ORIF of left wrist. Left wrist pain. There is a volar plate with screws affixing a fracture of the distal radius in near-anatomic alignment. I see no hardware complications. Portions of the fracture remain visible, but there is adjacent callus suggesting an attempt at healing. Severe osteoarthritis affects the first carpometacarpal joint. Overall, the bones appear slightly demineralized. | Orthopedic fixation of distal radius fracture as above. |
Generate impression based on findings. | Female 68 years old Reason: rule out perforation - cervical, mid and distal esophagus History: cervical web s/p dilation, Schatzki ring distally, s/p biopsy interruption Scout radiograph of the chest shows air space opacity in the right upper lung. A right chest terminates at the cavoatrial junction. There is atelectasis and consolidation adjacent to the left heart border. Residual contrast is noted within the colon.Single contrast esophagram is performed using Omnipaque 350. Confirming the absence of a esophageal leak. The study was repeated with thin barium. No leak was evident. Lateral view was not performed as the patient cannot tolerate.Follow up radiograph shows small amount of residual contrast within the distal esophagus and stomach.The study was only performed in the AP position as patient cannot tolerate a lateral view.TOTAL FLUOROSCOPY TIME: 2:56 minutes | No evidence of esophageal leak.Pulmonary opacity in the right upper lobe. |
Generate impression based on findings. | Male 23 years old Reason: left foot pain in sole, assess for foreign body History: as above. Three views of the left foot demonstrate perhaps soft tissue swelling, but we see no fracture, malalignment, or radiopaque foreign body. | No acute fracture, malalignment, or radiopaque foreign body. |
Generate impression based on findings. | Primary hyperparathyroidism. Please evaluate for parathyroid adenoma. There is physiologic distribution of the radiopharmaceutical. An abnormal focus of increased uptake is noted posterior to the mid to upper pole of the left thyroid lobe.The right thyroid lobe appears to measure 4.1 cm and the left lobe 4.1 cm in length. | Abnormal focus of uptake posterior to the mid to upper pole of the left thyroid pole is highly suspicious for a parathyroid adenoma. |
Generate impression based on findings. | 47 years, Male. Reason: Dobbhoff placement History: Dobbhoff placement Note that the pelvis is excluded from the field-of-view. Enteric feeding tube tip projects over the gastric body. Support devices and pleural effusions are unchanged. | Enteric feeding tube tip projects over the gastric body. |
Generate impression based on findings. | Reason: h/o HNC and CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: No evidence of pulmonary or pleural metastases, or other significant abnormalities.Stable basilar linear scarring.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy.A large amount of thrombus in the left subclavian artery causes moderate luminal narrowing.There are no visible coronary calcifications, and the heart and pericardium appear normal.CHEST WALL: Mild degenerative abnormalities affect the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Unchanged splenic artery calcifications.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Large complex right renal cyst decreased in size, having already been evaluated by ultrasound at which time annual ultrasound follow-up was recommended.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Aortoiliac calcifications noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative abnormalities affect the lumbar spine with nonspecific sclerosis.OTHER: No significant abnormality noted. | 1. No evidence of metastases, or other significant abnormality.2. Large right renal cyst decreased in size, for which annual ultrasound has been previously recommended. |
Generate impression based on findings. | 82-year-old male with abdominal pain, evaluate for small bowel obstruction. ABDOMEN:LUNG BASES: Left basilar subsegmental atelectasis, slightly increased from prior. There is chronic elevation of the left hemidiaphragm.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter left renal inferior pole low attenuation lesion too small to characterize but not significantly changed.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes of presumed right hemicolectomy are present. The distal jejunum and proximal ileum are fluid-filled and dilated up to 3.9 cm in diameter. There is a likely transition point in the right pelvis (series 3, image 126) after which the small bowel is collapsed. The colon just distal to the ileocolonic anastomosis demonstrates circumferential wall thickening and mucosal hyperenhancement with mild adjacent fat stranding. There is a second segment of transverse colon which also demonstrates wall thickening versus underdistention. No intraperitoneal free air.BONES, SOFT TISSUES: Severe degenerative changes of the thoracolumbar spine.PELVIS:PROSTATE, SEMINAL VESICLES: The prostate is enlarged.BLADDER: No significant abnormality notedBONES, SOFT TISSUES: Right-sided moderate hydrocele. Severe degenerative changes of the thoracolumbar spine. | 1.Postsurgical changes of right partial colectomy.2.Small bowel obstruction with transition point in the right lower quadrant.3.Two segments of colitis involving the colon just distal to the ileo-colonic anastomosis which may be due to infectious, inflammatory, or less likely ischemic etiologies.4.Prostatomegaly.Findings communicated with Dr. Saint-Hilaire at 2:00 p.m. on 2/20/2015. |
Generate impression based on findings. | Inflammatory myeloradiculopathy. The etiology could be CMV, tuberculosis, inflammation, infection or cancer. Please evaluate. RADIOPHARMACEUTICAL: 7.8 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 79 mg/dL. Today's CT portion grossly demonstrates opacification of the right sphenoid sinus and an air-fluid level in the right maxillary sinus. There is moderate to severe coronary artery calcifications. There is a calcified left hilar lymph node and left lower lobe calcified granuloma. There is mild ground glass opacity in the bilateral upper lobes and left perihilar region. There is ascites and splenomegaly. A foley catheter is noted in the bladder along with foci of air. There are multilevel degenerative changes of the spine. There is edema of the body wall soft tissues. Today's PET examination demonstrates increased activity within the endplates of L2-L3 (max SUV = 8.5). Otherwise, no suspicious FDG avid lesion is identified. Activity in the right hand and forearm is due to infiltration of injected tracer. | Increased activity within the endplates of L2-L3; degenerative change is favored over the possibility of infection. This appearance is not consistent with tumor. No other evidence of an FDG avid lesion. |
Generate impression based on findings. | Liver lesion. Question of metastases. Patient also reports fall on left side a few weeks ago. No abnormal osseous foci are identified to indicate metastatic disease. Increased areas of uptake along several anterolateral lower left ribs is compatible with likely healing fractures from prior trauma. There is slightly abnormal bilateral renal parenchymal retention of the radiotracer. | 1. No evidence of bone metastases.2. Slightly abnormal renal radiotracer retention; this may be due to dehydration or parenchymal dysfunction, clinical correlation is suggested. |
Generate impression based on findings. | Cirrhosis. Liver lesion. Evaluate for metastases. History of sarcoidosis. LUNGS AND PLEURA: Upper and mid zone predominately perilymphatic distribution of numerous micronodules and right upper lobe conglomerate mass with coarse calcifications, consistent with sarcoidosis, not significantly changed.Calcified nodules consistent with healed granulomatous disease.No new or enlarged nodule suspicious for a metastasis.Large left pleural effusion, new from prior.MEDIASTINUM AND HILA: Multiple calcified mediastinal and symmetric hilar lymph nodes consistent with sarcoidosis and/or prior granulomatous infection, unchanged. No new lymphadenopathy.No pericardial effusion. Mild coronary artery calcification.Enlarged retrocrural lymph node (series 4, image 74), unchanged. Small hiatal hernia. Irregular nodular contour of distal esophagus suggestive of esophageal varices. CHEST WALL: Bilateral gynecomastia.Mild degenerative changes of the thoracic spine.Chronic deformities of the left 8th and 9th ribs.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Large amount of abdominal ascites and varices.Cirrhotic liver morphology. Right hepatic lobe cyst. The two known HCCs seen on recent MRI are not well-visualized on this noncontrast exam. | Extensive sarcoidosis related lung disease, unchanged. No specific evidence of metastatic disease. Large left pleural effusion, new from prior. |
Generate impression based on findings. | Male 60 years old Reason: ETOH cirrhosis, please evaluate for presence of PVT clot and HCC History: ETOH cirrhosis PORTAL VENOUS: Flow in the main portal vein is very slow near the hepatic hilum and could not be demonstrated as the main portal vein courses in the liver. This may represent either very slow, sluggish flow versus occlusion of the main portal vein.HEPATIC ARTERIES: No significant abnormality noted.HEPATIC VEINS: No significant abnormality noted.INFERIOR VENA CAVA: No significant abnormality noted.OTHER: Liver is cirrhotic and is extremely coarse and heterogeneous echotexture. No focal liver lesions are seen. No evidence of cholelithiasis or biliary dilatation.Spleen measures 14 cm. Right kidney measures 12 cm. Left kidney measures 13 cm. No hydronephrosis. Normal echogenicity. There is a simple cyst in left kidney measuring 2.5 x 2.3 cm. | Possible thrombosis of the main portal vein. Further evaluation with contrast enhanced CT or MRI is recommended to differentiate between very slow flow versus thrombosis.Cirrhotic liver. |
Generate impression based on findings. | Reason: h/o recurrent met HNC, s/p chemotherapy. compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: 9 x 13 mm right upper lobe nodule image 29 series 5, present as far back as 10/29/2010 and relatively stable in size and likely benign.Severe centrilobular emphysema unchanged.MEDIASTINUM AND HILA: Benign appearing mediastinal lymph nodes unchanged since recent studies, and smaller than in 2010.Stable ectatic ascending calcified aorta, 4.3 cm.Severe coronary calcifications are present, and the heart is moderately enlarged.Hiatal hernia unchanged. CHEST WALL: Status post median sternotomy with wire sutures.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Unchanged slightly hypoattenuating splenic mass unchanged, previously described as a hamartoma.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Unchanged infrarenal abdominal aortic aneurysm with an aortoiliac graft. BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. No evidence of metastases.2. Right upper lobe nodule unchanged since 2010 and likely benign or a very indolent primary lung cancer.3. Severe emphysema.4. Infrarenal abdominal aortic aneurysm, unchanged following repair. |
Generate impression based on findings. | Female 50 years old Reason: r/o recurrence History: h/o thyroid cancer. S/p surgery. No RAI RIGHT LOBE: Status post thyroidectomy.LEFT LOBE: Status post thyroidectomy. Previously noted hyperechoic focus in the left thyroid bed is unchanged measuring 1.2 x 0 .8 cm.ISTHMUS: No significant abnormality noted.PARATHYROID GLANDS: No significant abnormality noted.LYMPH NODES: Benign-appearing lymph nodes in the neck.OTHER: No significant abnormality noted. | No significant change from previous study. |
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 composed of scattered fibroglandular elements. 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: NSB - Screening Mammogram. |
Generate impression based on findings. | Rheumatoid arthritis Right hand: Increased continued demineralization limits sensitivity, however the appearance remains essentially unchanged with diffuse rheumatoid changes including pronounced swan-neck and boutonniere deformities. Pencil in cup erosion with questionable complete dislocation of third, fourth and fifth PIP articulations. No distinct discrete erosions or new superimposed focal acute abnormality. Extensive wrist deformities and partial ankylosis of the carpus again unchanged. Ulnar subluxation. Relative sparing of the distal articulationsLeft hand: Again similar appearance with extensive rheumatoid changes and relative sparing of the DIP articulations. Volar subluxation involving the second through fifth MCP and more mild pencil in cup deformities again greater involving the fifth PIP appear similar. Partial ankylosis of the wrist with ulnar subluxation and superimposed severe osteoarthritic changes. No new erosions, acute change or soft tissue findings | Essentially stable extensive severe rheumatologic changes involving both hands |
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. The breast parenchyma is mostly fatty replaced, 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: NSA - Screening Mammogram. |
Generate impression based on findings. | 64 years, Male. Reason: ng tube location History: dec ng output Enteric feeding tube tip is past the ligament of Treitz. Multiple pigtail drains project over the left upper quadrant. A pancreatic stent is noted. Left sided pleural effusion. Nonobstructive bowel gas pattern. | Enteric feeding tube tip is past the ligament of Treitz. |
Generate impression based on findings. | 44-year-old with metastatic breast cancer recurrent malignant pleural effusion with pleurex catheter and fevers. LUNGS AND PLEURA: Diffuse pulmonary metastases. Large multiloculated right pleural fluid collection with layering in dependent debris, likely blood or cellular products. The largest area of loculation occurs along the lateral and subpulmonic portion of the pleural space extending from approximately the anatomic level of the azygos arch to the costophrenic angle (largest transaxial dimensions of approximately 13.7 x 7.2 cm (3/56).Right pleurex catheter enters the thorax at the right sixth/seventh rib interspace anterolaterally, coursing medially to abut the mediastinum then cranially in the posterior pleural space to terminates at the level of the posterior fifth rib level. There is a very small amount of air contained in the right pleural loculation which may be iatrogenic.Smooth visceral and parietal pleural thickening is noted on the right. The right middle lobe remains chronically collapsed and heterogeneous in attenuation suggesting internal hypoperfusion and tumor. The airways are intermittently obstructed.MEDIASTINUM AND HILA: Soft tissue infiltration of the right paramediastinal counts throughout its length. Scattered enhancing micronodule densities contained within the mediastinal fat are consistent with small lymph nodes.Pulmonary artery branches to the right middle lobe are very small or chronically occluded.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Known hepatic lesions are not visible by this technique. | Large complex loculated fluid collection in the right hemithorax with development of internal layering of fluid consistent with blood or cellular products. Thickening of both of the visceral and parietal pleural surfaces is more pronounced compared to previous examinations and is now compatible with superimposed empyema. Postobstructive pneumonia within the chronically collapsed right middle lobe cannot be excluded. Findings discussed with the referring clinical service at the time of dictation. The majority of the pleurex catheter length is situated within the loculated component of the fluid collection. |
Generate impression based on findings. | No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. Sulci and ventricles are within normal limits for age without evidence of hydrocephalus. No extra-axial collections. There are scattered areas of hypoattenuation in the periventricular and subcortical white matter which are nonspecific but favored to represent chronic small vessel ischemic changes. There is asymmetric volume loss involving the right cerebellar hemisphere which may related to prior small infarcts.CTA HEAD | 1. 7 x 6 mm aneurysm involving the right middle cerebral artery bifurcation. There is 2.5 mm aneurysm at the left middle cerebral artery bifurcation. 2. Right vertebral artery is occluded from its origin with flow within the right V4 segment and right posterior inferior cerebellar artery, which may be retrograde. Mild fusiform dilatation is noted at the confluence of the vertebral artery-basilar artery junction.3. Mild atherosclerotic changes involving the bilateral internal carotid and left vertebral arteries without flow-limiting stenosis. |
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 composed of scattered fibroglandular elements. A small circumscribed mass is present at upper quadrant in the right breast.No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Right hemiparesthesia Head:No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No abnormal parenchymal or meningeal enhancement. No midline shift or uncal herniation. Gray-white differentiation is maintained. No extra-axial collections. Ventricles are within normal limits without evidence of hydrocephalus.The visualized portions of the paranasal sinuses are clear. Mastoid air cells are clear. Calvarium is intact.Cervical Spine:There is prominent enhancement involving the venous plexus. The cervical vertebral bodies are appropriate height. There is loss of normal cervical lordosis, which may be in part positional. Alignment is otherwise maintained. No fractures are identified in the cervical spine. No suspicious bony lesions are identified in the cervical spine.Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is mild to moderate right neural foraminal stenosis. No significant compromise to the spinal canal or left neural foramen.C4-5: There is disk bulge with mild spinal canal stenosis suspected. There is mild right neural foramina stenosis related to uncovertebral hypertrophy. No significant compromise to the left neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina. C6-7: No significant compromise to the spinal canal. There is mild bilateral neural foramina narrowing, relatively worse on the left.C7-T1: No significant compromise to the spinal canal or right neural foramina. There is mild left neural foramina narrowing.Paraspinous soft tissues are unremarkable. | . 1. No intracranial mass or mass-effect. No abnormal enhancement. 2. Prominent enhancement of the epidural venous plexus, which may be related to increased central venous pressure. There are mild degenerative changes including mild to moderate right neural foraminal narrowing at right C3-C4 level. |
Generate impression based on findings. | Patient fell. Pain, check for fracture Hand and wrist: No radiographic abnormality. Specifically no findings to suggest a fracture or malalignment. Soft tissues are unremarkable. | Normal |
Generate impression based on findings. | Ms. Jackson is a 68 year old female presenting for a short-term followup for calcifications in the left breast. She has no current breast related complaints. Three standard views of the left breast, additional left MLO view and three left spot magnification views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. There are a loose grouping of round calcifications identified in the left upper outer breast, which have not changed in appearance or distribution when compared to the prior exam. Several ovoid partially circumscribed masses are identified in the left breast, which are stable when compared to prior exam. There are no new areas of architectural distortion identified in the left breast. | High probability benign calcifications in the left breast. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended in 6 months to confirm stability of these findings. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months). |
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 heterogeneously dense, unchanged in pattern and distribution. Scattered benign calcifications are unchanged in both breasts.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: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | 45 years, Female. Reason: evaluate for progression of ileus History: abd pain Enteric feeding tube tip projects over the gastric fundus. Ileus type bowel gas pattern is mildly improved compared to prior examination. | Ileus type bowel gas pattern is mildly improved compared to prior examination. |
Generate impression based on findings. | Female 72 years old Reason: gi bleeding History: anemia, gi bleeding ABDOMEN:LUNGS BASES: Emphysematous changes with mild bibasilar atelectasis.LIVER, BILIARY TRACT: Hypodense lesion in the dome of the liver likely representing hepatic cyst. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Nonobstructing right renal stone. Bilateral hypodense renal lesions consistent with simple renal cysts.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Endoscopic capsule within the ascending colon. No evidence of intraluminal enhancement to suggest gastrointestinal bleeding.BONES, SOFT TISSUES: Moderate degenerative changes of the visualized spine.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of intraluminal enhancement to suggest gastrointestinal bleeding.BONES, SOFT TISSUES: Moderate degenerative changes of the visualized spine.OTHER: No significant abnormality noted. | No CT evidence of gastrointestinal bleeding. |
Generate impression based on findings. | Male 43 years old Reason: evaluate vasculature to support kidney transplant History: weak distal pulses The study is limited due to lack of oral and IV contrast. Evaluation of the visceral organs and bowel loops is extremely limited.ABDOMEN:LUNG BASES: New small pleural effusion. Cardiomegaly.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant calcifications are noted in the abdominal aorta and major branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Generalized anasarcaOTHER: 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 | No significant atherosclerotic calcifications. Extremely limited study due to lack of oral and intravenous contrast. Generalized anasarca, cardiomegaly and right-sided pleural effusion. |
Generate impression based on findings. | Check fracture Indistinct margins to the distal fibular fracture without change in overall near anatomic alignment. Appearance is compatible with mild interval continued healing. Soft tissue swelling persists greater laterally | Interval partial healing of the distal fibular fracture |
Generate impression based on findings. | 82 years, Male. Reason: pt with diarrhea, rule out overflow diarrhea related to partial obstruction History: diarrhea Nonobstructive bowel gas pattern with average stool burden in the colon. Surgical coils project over the left hemipelvis. | Nonobstructive bowel gas pattern with average stool burden in the colon. |
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. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Circumscribed masses in both breasts are stable.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: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 85 years, Female. Reason: distension History: sepsis Nonobstructive bowel gas pattern. Less than average stool burden in the colon. | Nonobstructive bowel gas pattern. |
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. The breast parenchyma is composed of scattered fibroglandular elements, 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: NSB - Screening Mammogram. |
Generate impression based on findings. | Male 57 years old Reason: Patient with stage IVA Waldenstrom's Macroglobulinemia now s/p 6 cycles of CRD in need of reimaging History: Waldenstrom's Macroglobulinemia CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Index anterior mediastinal lymph nodes measure 4.6 by 1.3 cm on image number 31, series number 3, not significantly changed from previous study.CHEST WALL: Index right axillary lymph node measures 1.4 by 1 cm on image number 29, series number 3, not significantly changed from previous study. Other bilateral axillary enlarged lymph nodes are also grossly stable. Nonspecific, mixed sclerotic and lytic lesions in the bones are stable.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Index collection of lymph nodes in the retroperitoneum measures 5.9 by 2.7 cm on image number 127, series number 3, not significantly changed from previous study. Other retroperitoneal lymph nodes are stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Nonspecific, mixed sclerotic and lytic bone lesions are stable.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Index right inguinal collection of lymph nodes measures 5.4 by 2.4 cm on image number 222, series number 3, not significant changed from previous study. Other pelvic lymph nodes are also unchanged.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Nonspecific lytic and sclerotic bone lesions are stable.OTHER: No significant abnormality noted | Limited study due to lack of intravenous contrast. No significant change from previous study. |
Generate impression based on findings. | 71 year-old woman with history of right breast-cancer status post lumpectomy and radiation 19 years ago, recently with a right axillary recurrence that is status post excision. Evaluate for recurrent breast tumor. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. Dystrophic calcifications in the right upper outer breast and volume loss is compatible with given history of lumpectomy. No dominant mass, suspicious microcalcifications or areas of architectural distortion are seen in either breast. A large, circumscribed mass is seen in the right axilla but is only partially visualized on mammogram.ULTRASOUND | 1. Post-operative findings of right lumpectomy without mammographic evidence of malignancy. Continued followup with surgery and oncology are recommended for treatment planning. Results and recommendation were discussed with the patient. MRI could be considered if further evaluation of the breast is needed. 2. Large post-operative fluid collection in the right axilla without evidence of malignancy.BIRADS: 2 - Benign finding.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
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. The breast parenchyma is composed of scattered fibroglandular elements, 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: NSB - Screening Mammogram. |
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 heterogeneously dense, unchanged in pattern and distribution. Arterial calcifications and few benign calcifications are noted in both breasts. 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: NSC - Screening Mammogram. |
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. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. There are a few arterial and other benign calcifications. 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: NSB - Screening Mammogram. |
Generate impression based on findings. | Medulloblastoma status post craniotomy and induction chemotherapy History: Infectious work up pre-transplant. The images are degraded by patient motion. There is moderate mucosal thickening in the right maxillary sinus. There is also patchy opacification of the ethmoid and sphenoid sinuses. The nasal cavity is also clear. The nasal septum is essentially midline. The lamina papyracea and ethmoid roofs are intact. The carotid grooves and optic canals are covered by bone. The nasopharynx, facial soft tissues, and orbits appear to be unremarkable. There are partially imaged findings related to posterior fossa surgery. | Scattered paranasal sinus opacification may represent sinusitis. |
Generate impression based on findings. | Female 56 years old Reason: new lung nodule, response to chemotherapy? History: new lung nodule, response to chemotherapy? CHEST:LUNGS AND PLEURA: Severe emphysema again noted. Index opacity in the left lower lobe is no longer visualized. However, there is new right lower lobe consolidation which represents pneumonia. There is also new subcentimeter nodule in the right upper lobe measuring 6-mm in diameter image number 29, series number 4. Another new subcentimeter nodule is in the left lower lobe measuring 8-mm in diameter image number 75, series number 4.MEDIASTINUM AND HILA: Borderline enlarged mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple hepatic hemangiomas unchanged.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Right adrenal nodule measures 10 by 8 mm on image number 88, series number 3, slightly smaller compared to previous study.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Sclerotic left sacral lesion and iliac lesions are stable. No new bone lesions.OTHER: No significant abnormality noted. | Interval resolution of the left lower lobe nodule. Interval development of right lower lobe also location which may represent pneumonia.Slight interval decrease in the size of the right adrenal nodule.Sclerotic pelvic bone lesions are stable. |
Generate impression based on findings. | Female 69 years old Reason: mets lung cancer. s/p 14 cycles of MPDL3280A. Pls c/w previous study and evaluate tx response. History: lung ca ABDOMEN:LUNG BASES: Chest CT will be dictated separately.LIVER, BILIARY TRACT: Multiple cystic hepatic lesions are unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal cyst and small hypodensities are unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes with compression fracture at T10 vertebral body, again noted.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No significant change from previous study. |
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. The breast parenchyma is heterogeneously dense, 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: NSC - Screening Mammogram. |
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