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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. A percutaneously placed clip is present in the left upper outer quadrant, unchanged in position. 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: NSB - Screening Mammogram. |
Generate impression based on findings. | Reason: yearly follow up with CTA sp craniotomy aneurysm clipping wth 2nd untreated aneurysm, evaluate for changes History: yearly follow up, pain Brain CTA: There is redemonstration of a 3.5 x 5 mm aneurysm at the right carotid terminus which is directed superiorly. It previously measured the same. The patient is status post a left-sided craniotomy for left carotid terminus aneurysm clipping and left paraclinoid aneurysm clipping. There is a significant amount beam hardening artifact present which obscures visualization for residual aneurysm.There is a focus of encephalomalacia present adjacent to the frontal horn of the left lateral ventricle and adjacent basal ganglia.There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are intact.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Atherosclerotic calcifications are present along the distal internal carotid arteries. | 1.A right ICA terminus aneurysm remains stable compared to the prior exam.2.There is a significant amount beam hardening artifact present which obscures visualization for residual aneurysms at the distal left internal carotid artery. |
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. | Metastatic lung cancer treated with 14 cycles of MPDL3280A. There is apparent interval increase in size of an ill-defined conglomerate of right level 4 lymph nodes, which measures up to 19 x 20 mm, previously 12 x 16 mm. There is also interval increase size of the necrotic right paratracheal lymph node, which measures up to 17 x 26 mm, previously 15 x 24 mm. The heterogeneous left upper mediastinal lymph node now measures up to approximately 30 mm, previously 25 mm. The lymph nodes have ill-defined margins, which may indicate extracapsular extension. There are findings related to right vocal cord augmentation in which the calcium hydroxyapatite paste has partially resorbed. The right jugular vein is unchanged and occluded distal to this point. The right common and internal carotid arteries are patent. The thyroid and major salivary glands appear unchanged. The airways are patent. The imaged intracranial structures are unremarkable. There is a mucosal retention cyst within the left maxillary sinus. There is unchanged cervical spondyloarthropathy. There are micronodules within the partially imaged lungs. | 1.Interval increase in size of the metastatic right cervical and upper mediastinal lymphadenopathy.2. Micronodules within the partially imaged lungs. Please refer to the separate chest CT report for additional details. |
Generate impression based on findings. | Pain. Right hip: The bones are demineralized. Moderate osteoarthritis affects the right hip. No fracture or malalignment is present.Lumbar spine: There is moderate multilevel degenerative disk disease, most prominent at L4/L5. There is grade 1 anterolisthesis of L4 on L5. The vertebral body heights are preserved. Severe facet arthropathy affects the lower lumbar spine. | Degenerative changes, as above. |
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, 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. The breast parenchyma is mostly fatty replaced, unchanged in pattern and distribution. A circumscribed mass in the right retroareolar region, and a 3 mm circumscribed mass in the right upper outer quadrant are unchanged. 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: NSA - 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 composed of scattered fibroglandular elements, unchanged in pattern and distribution. Lobulated mass with coarse calcifications in the right breast in the retroareolar region and two ovoid masses in the left anterior breast, one calcified and one not, are again seen. Scattered calcifications in both breasts have mildly progressed in benign fashion.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. | Surveillance exam for multiple subpleural nodules, previously read as probable infection. Malignant neoplasm of supraglottis. LUNGS AND PLEURA: Severe emphysema. Scarring and bronchiectasis in the right middle lobe, with several nodules and micronodules, some of which are new. The location and pattern is consistent with subacute atypical mycobacterial infection such as MAI. The previously measured peripheral subpleural nodule is decreased in size, now 1 cm in diameter (4/63), previously 1 cm in short axis and inseparable from adjacent nodules previously included in the length measurement. On the current study multiple new micronodules are seen surrounding the lesion.With the right lower lobe azygoesophageal recess and the left lower lobe numerous nodules are again seen, some of which are new however several of the previously seen nodules have improved in size. No pleural fluid or pneumothorax.MEDIASTINUM AND HILA: No visible coronary artery calcification lymphadenopathy. Normal heart size.CHEST WALL: Near complete occlusion of the left common carotid artery by thrombus; the opacified portion of the lumen measures 5-mm by 3-mm (3/2, level of the cranial aspect of the thyroid gland).UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. The left kidney is absent. The right kidney contains multiple cysts, some of which are in a subcapsular location. Additionally, numerous hepatic cysts are noted | Numerous pulmonary nodules, most consistent with active endobronchial spread of atypical mycobacterial infection such as MAI. |
Generate impression based on findings. | Hyperparathyroidism. Evaluate for adenoma. There is physiologic distribution of the radiopharmaceutical. A focus of increased radiotracer uptake is noted inferior to the lower pole of the left thyroid lobe. The right thyroid lobe appears to measure 4.4 cm and the left lobe 4.8 cm in length. | Focus of uptake inferior to the lower pole of the left thyroid lobe is suspicious for a parathyroid adenoma. |
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. There is a possible architectural distortion at lower outer quadrant in the right breast. No suspicious masses or microcalcifications are present. | A possible architectural distortion lower outer quadrant in the right breast, for which spot compression views and ultrasound study, if needed, are recommended. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EC - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The mastoid air cells are clear. | Negative noncontrast brain MRI. Specifically, there are no MRI findings to explain the patient's seizure. |
Generate impression based on findings. | Female 49 years old Reason: s/p radiation therapy to known rectal carcinoma, rising CEA, please compare to previous exam History: rectal cancer, lung nodules, rising CEA CHEST:LUNGS AND PLEURA: Stable, nonspecific pulmonary micronodules in the right upper lobe and left lower lobe (series 4, images 52 and 62), both of which may represent lymph nodes and are unchanged. No suspicious pulmonary nodule. No pleural effusion.MEDIASTINUM AND HILA: Heart size at the upper limits of normal without pericardial effusion. Subcentimeter right lower pole thyroid nodule.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: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Heterogeneous appearance of the uterus which may be secondary to underlying leiomyomatosis.BLADDER: No significant abnormality noted.LYMPH NODES: No regional lymphadenopathy delineated.BOWEL, MESENTERY: Anorectal region is unde distended and not well evaluated.BONES, SOFT TISSUES: Stable sclerotic lesion in the L4 vertebral body. The sacral spine appear slightly more lucent than previous exam and may be secondary to postradiation changes. | 1.No evidence of metastatic disease within the abdomen or pelvis.2.Nonspecific, stable pulmonary micronodules. 3.Heterogeneous appearance of the uterus which may be secondary to underlying leiomyomatosis. Recommend pelvic ultrasound to better characterize. |
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. History of benign biopsy of left axillary lymph node in 2014. 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. Multiple calcified and noncalcified masses are present in both breasts. No suspicious masses, microcalcifications or areas of architectural distortion are present. A marker clip is present within the left axillary lymph node, which is proven benign. | 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. | Ms. Grenoble is a 56 year old female recalled from screening mammogram for calcifications in the right breast. She has a family history of breast cancer in her paternal aunt. An ML view and two spot magnification views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Spot magnification views demonstrate a loose group of punctate calcifications in the central right breast. There is no new mass or areas of architectural distortion identified in the right breast. | Benign calcifications of the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Streaky hemoptysis right lower chest wall pain cough history of lung cancer 12 years ago. LUNGS AND PLEURA: Emphysema. Left apical pleural retraction and scarring unchanged. Left paramediastinal fibrosis. Right paramediastinal mass inseparable from adjacent lymphadenopathy, occluding the upper lobe apical segmental bronchus and its branches and causing bronchial wall thickening in both the anterior and posterior segments. Largest transaxial dimensions of the mass are 7.3 x 5.6 cm (3/34). The mass extends to be medial pleural surface and is inseparable from the prevertebral fat.Mild septal thickening right middle lobe. No pleural fluid. Postsurgical volume loss left upper lobe with stable appearance of the resection site over multiple prior studies.MEDIASTINUM AND HILA: Interval development of moderate right hilar and mediastinal lymphadenopathy. For reference, conglomerate lymphadenopathy in the right paratracheal region measures 3.5-cm in short axis (3/30), causing severe extrinsic compression of the superior vena cava. Right mainstem bronchus and bronchus intermedius are surrounded by lymphadenopathy, with mild narrowing of the airways. Lymphadenopathy in the subcarinal space bilaterally. Tumor is inseparable from the mid thoracic esophagus on some images.The right upper lobe pulmonary artery is occluded a tumor.CHEST WALL: Tumor in the subcarinal space and extends to the prevertebral fat of the mid thoracic spine but does not cause bony erosion. Healed left rib fracture deformities are chronic, no skeletal metastases are appreciated.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. | Confluent right hilar tumor and mediastinal lymphadenopathy with epicenter in the paramediastinal right upper lobe as detailed in the body of the report. This is most consistent with a new primary tumor as the site of the patient's treated contralateral tumor is unchanged over multiple prior examinations. SVC syndrome. |
Generate impression based on findings. | Ankle swelling Soft tissue swelling is present about the ankle. No fracture or malalignment is present. Note is made of an os trigonum. | Soft tissue swelling, without fracture or malalignment. |
Generate impression based on findings. | 23-year-old male with neutropenia, evaluate for sinusitis There has been interval progression of opacification throughout all the paranasal sinuses including superimposed air-fluid levels throughout. Additionally, new fluid is present within bilateral middle ear cavities and left mastoid air cells. Occlusion is present affecting bilateral ostiomeatal units, frontoethmoidal recesses, and sphenoethmoidal recesses. No orbital extension. The imaged intracranial structures are unremarkable. The nasal septum is mildly S-shaped. | There has been interval progression of opacification throughout all the paranasal sinuses including superimposed air-fluid levels throughout. Additionally, new fluid is present within bilateral middle ear cavities and left mastoid air cells. |
Generate impression based on findings. | Male 62 years old; Reason: Assess vasculature prior to kidney transplant; assess thoracic vessels History: pre-kidney transplant and Marfan-like habitus CHEST:LUNGS AND PLEURA: Multiple left lower lobe lung nodules, largest of which measures up to 7 mm, image 71 series 3. Calcified 3 mm right apical nodule, like a granuloma. Left base atelectasis/scarring. MEDIASTINUM AND HILA: Patent great vessels. Tiny subcentimeter mediastinal lymph nodes. Mild calcified coronary artery disease. Heart borderline in size. Heterogeneous thyroid gland with bilateral nodules incompletely imaged.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Multiple mildly complex liver lesions, most likely hepatic cysts. Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: Multiple dystrophic pancreatic calcifications, likely reflecting calcific chronic pancreatitis. Evaluation of underlying masslesion suboptimal on this nondedicated study.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Enlarged kidneys containing innumerable bilateral renal cysts, of varying size and internal attenuation with several demonstrating internal mildly complex fluid. A few of the cysts have associated calcifications. No definite associated soft tissue nodularity seen in postcontrast arterial phase of imaging. Largest cystic lesion on left side measures 12 x 10.4 cm, largest on right side measures 6.9 x 5.8 cm. Right kidney measures 15.4 cm, while left kidney measures 15 5 cm. Patent renal arteries, measuring 5 mm on right and 3 mm on left on transaxial imaging.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Sigmoid colon diverticulosis without evidence of acute diverticulitis. Normal appendix.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative disease of spine and scattered sclerotic foci, most likely bone islands. VASCULAR: Non-aneurysmal thoracic and abdominal aorta. Ascending aorta measures approximately 3 cm in diameter. Descending thoracic aorta measures approximately 2.4 cm at level of diaphragmatic hiatus. Suprarenal abdominal aorta measures 2 cm. Infrarenal abdominal aorta measures 1.8 cm. Ectatic right common iliac artery, measuring 1.6 cm, image 259 series 26, focal dissection involving right common iliac artery, measuring approximately 1.5 cm, image 265 series 526. Patent celiac and superior and inferior mesenteric arteries. | 1. Focal dissection involving ectatic right common iliac artery. 2. Multiple left lower lobe lung nodules, measuring up to 7 mm, correlation with patient's clinical history recommended, findings nonspecific and may be postinflammatory/infectious but underlying neoplastic process not excluded.3. Sequela of chronic calcific pancreatitis, please note that evaluation of underlying masslesion suboptimal on this nondedicated 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 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. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Multiple circumscribed masses in both breasts are unchanged.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. | 16 year old female with right knee pain instability after fallVIEWS: Right knee, AP, lateral, and oblique (3 views) 2/20/15 14:16 Alignment is anatomic. No fracture is visualized. A small joint effusion is noted. | Small joint effusion without fracture or dislocation. |
Generate impression based on findings. | T4aN2b right parotid oncocytic carcinoma, status post chemoradiation cycle 6/6 TFHX. Redemonstrated are postoperative findings related to right parotidectomy with free flap reconstruction and modified radical neck dissection. There is no definite evidence of measurable mass lesions. There is no significant cervical lymphadenopathy based on size criteria, although a few left level Ib and II lymph nodes appear slightly more prominent. The remaining salivary glands are unremarkable. The thyroid gland appears atrophic. The airways are patent. The major cervical vessels are patent. There are multilevel degenerative changes involving the cervical spine, which is most pronounced at C6-7, where there is at least mild spinal canal stenosis. There is also grade 1 anterolisthesis of C4 on C5 and C7 on T1. The imaged intracranial structures are unremarkable. The imaged portions of the lungs demonstrate mild emphysematous changes. There are bilateral lens implants. A right chest post is present. | 1. Postoperative findings related to right parotid tumor resection without evidence of measurable tumor. 2. Slight prominence of a few cervical lymph nodes, which are not enlarged based on size criteria with preserved fatty hila, may be reactive in nature. |
Generate impression based on findings. | Male 44 years old Reason: left ankle pain History: left ankle pain No acute fracture or dislocation. Ankle joint alignment is preserved. | No acute fracture or dislocation. |
Generate impression based on findings. | Removal of chest tubeVIEW: Chest AP 2/20/15 Right central line and epicardial pacer leads are again noted. Right chest tube has been removed in the interval. No evidence of pneumothorax. Cardiothymic silhouette at the upper limits of normal. Minimal patchy atelectasis left lower lobe. | Removal of right chest tube without evidence of pneumothorax. |
Generate impression based on findings. | Ms. McClain is a 81 year old female with a personal history of bilateral breast cysts. She has a personal history of cervical cancer diagnosed at the age of 51. No current breast-related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Scattered benign calcifications are present bilaterally. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Male 44 years old Reason: Right knee pain History: Right knee pain. Four views of the right knee demonstrate a partially imaged intramedullary rod within the distal femur without radiographic evidence of hardware complication. Osseous tunnels within the distal femur likely reflects prior ACL reconstruction. There are tiny tricompartmental osteophytes and mild sharpening of the tibial spines compatible with mild osteoarthritis. No acute fracture or dislocation.Frontal views of the left knee demonstrate mild degenerative arthritic changes. | Postsurgical changes of the right knee with mild osteoarthritis as described above. |
Generate impression based on findings. | Small cell, right upper lobe scarring. Is this recurrence? Cough. LUNGS AND PLEURA: Small right pleural effusion is new. Centrilobular and paraseptal emphysema. Bronchial wall thickening with adjacent groundglass opacities and architectural distortion, most consistent with radiation pneumonitis and evolving radiation fibrosis. The dominant right upper lobe nodule is smaller, measuring 15 x 12 mm (5/39), previously 19 x 16 mm. The smaller nodules seen previously are no longer distinguishable from adjacent radiation reaction.Right upper lobe apical and anterior segmental airways are now patent, though bronchial wall thickening remains.No suspicious contralateral lung nodules or nodules in other lobes.MEDIASTINUM AND HILA: Significant improvement in lymphadenopathy, now mild. For reference, a subcarinal lymph node measures 14 mm, previously 21-mm (4/49). Right hilar lymphadenopathy decreased to approximately 13 mm from a prior measurement of 36-mm (4/41). Contralateral mediastinal lymph nodes also decreased in size.Moderate coronary artery calcifications. Very small volume of pericardial fluid, new from the previous study.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. Probable cyst upper pole left kidney. Vascular calcifications. | Significant interval improvement in disease since the previous examination of 5/5/2014 with decrease in size of the dominant right upper lobe nodule and significant improvement in lymphadenopathy. Opacities in the right upper lobe are compatible with radiation pneumonitis. New small volume of pericardial and lateral pleural fluid may also be a result of radiation therapy but are nonspecific. |
Generate impression based on findings. | History of T4 laryngeal cancer with recurrence. RADIOPHARMACEUTICAL: 9.8 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 80 mg/dL. Today's CT portion grossly demonstrates an ill-defined irregularity within the right larynx. There is right middle and lower lobe atelectasis. There are severe coronary artery calcifications. There is calcific atherosclerotic disease of the aorta and its branches and a femoral to femoral bypass graft. There is soft tissue density around the distal aorta/proximal common iliac arteries. There is a left inguinal hernia containing colon without evidence of obstruction. Today's PET examination demonstrates increased activity in the right laryngeal and lower portion of the right oropharyngeal walls. This may represent recurrent or residual disease. Compared to the prior examination, this area has decreased in intensity (max SUV = 12.4 now, previously 22.1). The FDG avid lymph nodes seen on the prior examination have resolved.A focus of activity within the right prostate gland has decreased in size and activity (max SUV = 8.4 now, previously 11.5).There is degenerative uptake in the lower thoracic and lumbar spine.Increased activity is noted about the femoral-femoral bypass graft which is likely inflammatory change. | 1.Right laryngeal/oropharyngeal abnormal FDG uptake is highly suspicious for recurrent or residual disease, decreased from the prior examination. 2.Focus of activity within the right prostate gland has decreased.3.Left inguinal hernia containing colon without evidence of obstruction. |
Generate impression based on findings. | Female 88 years old Reason: right femur fracture s/p nail History: fracture. Sensitivity of the study is limited by overlying bowel gas and stool. The bones are diffusely demineralized. There is mild osteoarthritis of the hips. Again seen is an intramedullary rod and screw device with the attempt affixation of a comminuted intertrochanteric fracture of the femur. The proximal screw tip is unchanged in position and lies at the superior aspect of the femoral head and neck and the threads of the screw does not appear to be attached in the femoral neck or head. Femoral mid-diaphyseal screw is unchanged in position. Arterial calcifications are noted in the medial soft tissues. | Attempt orthopedic fixation of a comminuted intertrochanteric fracture unchanged in position. |
Generate impression based on findings. | History of metastatic medullary thyroid cancer. Compare to previous. Measurements please. CHEST:LUNGS AND PLEURA: Right middle lobe reference nodule is 23 x 21 mm (series 4, image 61), previously 21 x 20 mm, not significantly changed.Basilar subsegmental atelectasis and/or scarring, including along the left major fissure, similar to prior. Small nodular opacities in the left lower lobe (series 4, image 47), unchanged. Faint groundglass opacities bilaterally with interlobular septal thickening is suggestive of mild edema. No new suspicious pulmonary nodules.MEDIASTINUM AND HILA: Post-operative findings of left thyroidectomy.Mediastinal lymphadenopathy, some with necrosis, without significant interval change. Reference prevascular lymph node is 11 mm (series 3, image 25), previously 12 mm and low right paratracheal node is 15 mm, unchanged (series 3, image 33).Very small pericardial effusion, slightly increased. Mild cardiomegaly.No visible coronary artery calcification.Necrotic cervical lymphadenopathy, refer to separate same day CT head/neck report.CHEST WALL: No axillary lymphadenopathy.Mild degenerative changes of the thoracolumbar spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Extensive infiltrative hepatic metastases without significant interval change.Stable left hepatic lobe cyst.Cirrhotic liver morphology.Cholelithiasis.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: Mildly enlarged retroperitoneal lymph nodes, unchanged. Prominent abdominal vasculature, unchanged.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Mild degenerative changes of the thoracolumbar spine.OTHER: Small amount of abdominal ascites, mostly perihepatic. | Stable metastatic disease. Findings suggestive of mild pulmonary edema. |
Generate impression based on findings. | Female 44 years old; Reason: evaluate for metastasis. History: colon cancer; desmoid. CHEST:LUNGS AND PLEURA: Scattered micronodules. No dominant lung lesion. The pleural spaces are clear.MEDIASTINUM AND HILA: Heart size is normal. No pericardial effusion. There are calcified right hilar lymph nodes. No coronary calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Liver is hypoattenuating compatible with fatty infiltration. No definite hepatic lesion. The hepatic and portal veins are patent.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Few scattered retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: Postsurgical changes from colon resection.BONES, SOFT TISSUES: Postsurgical changes in the anterior abdominal wall from prior desmoid tumor resection. The fluid collection in the left rectus muscle has decreased in size. There is some fat stranding within the musculature and mild nodularity.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomyBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post colectomyBONES, SOFT TISSUES: Postsurgical changes in the anterior abdominal wallOTHER: No significant abnormality noted. | 1.Status post resection of the abdominal wall lesions and the colon. No definite CT evidence of metastatic disease. |
Generate impression based on findings. | 54 year old woman with focal asymmetry seen on screening mammogram in the right breast. Three standard views and 2 spot compression CC and ML views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. The focal asymmetry in the upper right breast appears stable, measuring 27 mm. This asymmetry disperses on the ML compression view but persists on the CC compression view. There are no additional dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. ULTRASOUND | Mammographic asymmetry which disperses on ML compression view and for which no sonographic correlate could be found. Recommend returning to diagnostic mammography in 6 months to confirm stability (a bilateral mammogram will be due at that time) and also obtaining old studies for comparison if available. Results and recommendations discussed with patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (6 Months) and O - Old Study For Comparison. |
Generate impression based on findings. | Pedestrian versus automobile. Right shoulder pain. No fracture or malalignment. No significant abnormality otherwise noted. | No radiographic findings to account for the patient's symptoms. |
Generate impression based on findings. | Ms. Smith is a 58 year old female with a personal history of right breast lumpectomy in 2008 and left breast lumpectomy in 2014 for IDC followed by radiation and hormonal therapy. She has no current breast related complaints. Three standard views of both breasts and three left spot magnification views 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, skin thickening and coarse benign dystrophic calcifications present within the right lumpectomy site. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast. A linear marker was placed on the scar overlying the left breast. There are stable postsurgical changes including architectural distortion, increased density, skin thickening and surgical clips present within the left lumpectomy site. There are several diffusely scattered amorphous calcifications identified just inferior to the left lumpectomy site which persist on the spot magnification views. There is no new mass or 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, left unilateral 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. | 57 year-old male with history of pancreatic cyst, surveillance. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter hypodensities in the right hepatic lobe too small to characterize but are not significantly changed and are likely benign. Gallbladder is no longer distended. SPLEEN: No significant abnormality notedPANCREAS: There is a 5 mm low attenuation focus, attenuation has appearance of fat, within the head of the pancreas (series 6, image 57), unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral subcentimeter low attenuation renal lesions too small to characterize but likely benign.RETROPERITONEUM, LYMPH NODES: Mildly prominent subcentimeter nonspecific retroperitoneal lymph nodes are similar to prior.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: There is apparent atrophy of and calcifications within the medial aspect of the right rectus femoris muscle likely related to prior injury. | 1.Hypodense 5 mm lesion within the head of the pancreas unchanged and given apparent fat attenuation, consistent a benign lipoma. |
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, 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. | History of prior stroke with slurred speech and left facial droop, with unclear time of onset. Evaluate for stroke and intracranial hemorrhage. There is no evidence of acute intracranial hemorrhage or mass effect. The ventricles and sulci are mildly prominent, consistent with mild parenchymal volume loss. There is encephalomalacia in the left cerebellar hemisphere, which likely represents prior infarct. There are lacunar infarcts in the bilateral basal ganglia, which are age-indeterminate. There is no midline shift or herniation. There are intracranial vascular calcifications. The imaged paranasal sinuses and mastoid air cells are clear. There is a fat-attenuating right frontal scalp lesion measuring up to 22 mm, consistent with a lipoma. The skull and extracranial soft tissues are otherwise unremarkable. | 1. No evidence of acute intracranial hemorrhage, edema or mass effect.2. Encephalomalacia of the left cerebellar hemisphere, related to a prior infarct. Please note that CT is insensitive for the early detection of acute nonhemorrhagic ischemic event. If there is continued clinical concern and no contraindications, MRI of the brain is recommended. |
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. | Male 30 years old Reason: neck pain History: Left UE radiculopathy. Vertebral body heights and intravertebral disk spaces are preserved. No acute fracture or malalignment is seen. Neuroforamina are patent. | No radiographic evidence to account for patient's finding. If further imaging is clinically warranted an MRI is recommended. |
Generate impression based on findings. | 19 year-old female, knee gave out with swellingVIEWS: Right knee, AP, oblique, and lateral (3 views) 2/20/15 14:41 Interval placement of two orthopedic screws affixing the tibial tubercle without evidence of hardware complication. The patella tendon appears thin. Small ossicle anterior to tibial plateau is likely chronic. No acute fracture or malalignment. | No acute fracture or dislocation and additional findings as described above. Discussed with Dr. Mitchell (pager 9946) at the time of dictation. |
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. |
Generate impression based on findings. | Newly diagnosed locally advance left base of tongue cancer. Neck: There is an infiltrative mass centered in the left tongue base region with extension into the oral tongue and across the midline, as well as invasion of the left mylohyoid muscle and left submandibular space. Overall, the mass measures approximately up to 5 cm, but is partially obscured by dental streak artifact, which precludes accurate assessment of pterygoid muscle involvement. There is partial effacement of the oropharyngeal airway. There are numerous abnormal left cervical lymph nodes. For example, a left level 2A lymph node measures 18 x 24 mm, a left level 1 lymph node measures 10 x 10 mm, and a lower left level 2B lymph node measures 9 x 11 mm. Many of these lymph nodes display areas suggestive of necrosis and extracapsular extension. Although not significantly enlarged, a right level 2B lymph node that measures 8 x 9 mm and a right level 3 lymph node that measures 8 x 10 mm appear abnormal. Aside from the left submandibular gland, which appears to be affected by surrounding tumor, the other salivary glands are unremarkable. The thyroid gland appears mildly enlarged diffusely. The major cervical vessels are patent. There are mild degenerative changes in the cervical spine. There is mucosal thickening in the right maxillary sinus. The imaged intracranial structures are unremarkable. There are calcified granulomas in the left lungs and hilar lymph nodes. There are postoperative findings related to cardiac surgery.Head: There is no evidence of intracranial mass or abnormal enhancement. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | 1. An infiltrative mass centered in the left tongue base region with extension into the oral tongue and across the midline, as well as invasion of the left mylohyoid muscle and left submandibular space is compatible with squamous cell carcinoma. Overall, the mass measures approximately up to 5 cm, but is partially obscured by dental streak artifact, which precludes accurate assessment of pterygoid muscle involvement. 2. Extensive left cervical lymphadenopathy compatible with metastatic disease, perhaps with associated extracapsular extension. Although not significantly enlarged, right level 2 and 3 lymph nodes may also contain metastatic disease.3. No evidence of intracranial metastases. |
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, unchanged in pattern and distribution. There is a new mass at anterior upper outer quadrant in the right breast. No suspicious microcalcifications or areas of architectural distortion are present. | New mass at anterior upper outer quadrant in the right breast, for which spot compression views and possible ultrasound study are recommended. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EB - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | 23-year-old male with history of AML presents with productive cough. LUNGS AND PLEURA: Scattered nodular ground glass opacities are again noted with interval improvement in tree-in-bud opacities previously seen in the right lung. No focal areas of consolidation or pleural effusions.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No mediastinal or hilar lymphadenopathy.CHEST WALL: Left central venous catheter tip in right atrium. No axillary lymphadenopathy.UPPER ABDOMEN: No acute process identified in the upper abdomen. | Interval improvement in tree in bud opacities with persistent scattered nodular ground glass opacities. Findings can be seen in the setting of airway inflammation or aspirated secretions. |
Generate impression based on findings. | Right knee pain. RIGHT KNEE: The right knee is normal in appearance without significant degenerative changes. No large joint effusion is evident.RIGHT HIP/PELVIS: Mild osteoarthritis affects the right hip. No significant abnormality is otherwise evident. | Mild right hip osteoarthritis. |
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. |
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. | 58 year old female with history of metastatic uterine cancer undergoing neoadjuvant chemotherapy. ABDOMEN:LUNG BASES: Subcentimeter cardiophrenic lymph nodes continue to decrease in size.LIVER, BILIARY TRACT: Metallic biliary stent in place with expected pneumobilia. Stable minimal intrahepatic biliary ductal dilatation. No suspicious liver lesion is identified. Several enlarged porta hepatis lymph nodes and ill-defined soft tissue attenuation at the hepatic hilum are again present. Reference lymph node (series 3, image 46) measures 2.6 x 2.0 cm, measured 2.6 x 2.2 cm previously. Hepatomegaly is again noted with the liver measuring up to 25 cm in length.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal lesion is higher density than expected for a simple cyst and incompletely characterized. RETROPERITONEUM, LYMPH NODES: Mildly prominent retroperitoneal lymph nodes appear similar to prior.BOWEL, MESENTERY: There has been interval repair of the ventral hernia. Normal caliber bowel without evidence of obstruction. Lipomatous hypertrophy of the ileocecal valve, a benign variant. BONES, SOFT TISSUES: Interval surgical changes to the anterior abdominal wall. A small amount of nonspecific fluid/edema is present along the superficial aspect of the mesh. No associated foci of gas are present. Interval decrease in peritoneal soft tissue implants. Previously described reference implant is no longer present. For reference, current largest implant (series 3, image 67) measures 1.0 x 1.0 cm. PELVIS:UTERUS, ADNEXA: Interval hysterectomy.BLADDER: No significant abnormality notedLYMPH NODES: See below. BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Previously described soft tissue mass in the right lower rectus abdominal muscle is no longer discretely identified. There is a large conglomerate of lymph nodes (series 3, image 107) encasing the right external iliac vessels which has increased in size. This conglomerate has ill-defined margins with the surrounding muscle. The right external vein is not visualized and is likely occluded. The right iliac artery is also narrowed. Reference left external iliac lymph node (series 3, image 108) measures 1.9 x 2.8 cm, previously 2.4 x 3.5 cm. Right greater than left inguinal lymphadenopathy is also present. | 1.Interval hysterectomy and debulking with decrease in number and size of peritoneal implants.2.Interval ventral hernia repair. Small amount of edema superficial to the hernia repair mesh which is nonspecific. Previously seen right rectus sheath mass is no longer discretely visualized.3.Slight interval increase in large conglomerate of right external iliac lymph nodes. Additional reference lymph nodes stable to slightly decreased.4.Incompletely characterized left renal lesion. In the appropriate clinical setting, dedicated triple phase renal CT may be helpful for further evaluation. |
Generate impression based on findings. | Female 44 years old Reason: Evaluate for avulsion fracture medial ankle History: Pain and edema medial ankle left along course of tibialis posterior tendon. There is mild soft tissue swelling along the dorsal aspect of the foot. There is no underlying fracture or malalignment. Ankle joint space is preserved. | No acute fracture or malalignment. |
Generate impression based on findings. | Male, 45 years old, with low back pain, status post fusion L4 through S1 in 2011. Instrumented posterior spinal fusion has been performed from L4 through S1. Bilateral pedicle screws are present at each of these levels and affixed to posterior stabilization rods. The screws are well seated and no instrument complications are suspected. Intervertebral devices have been placed in the L4-5 and L5-S1 disk spaces.Spinal alignment is anatomic. Except where altered by surgery, ventricular morphology is unremarkable. Vertebral body height is preserved throughout. No destructive osseous lesions are seen.L1-2: Left paracentral disk protrusion causing mild effacement of the left ventral thecal sac. Mild bilateral foraminal narrowing. L2-3: Mild facet hypertrophy. No significant degenerative disk disease, spinal canal stenosis or neuroforaminal narrowing. L3-4: Facet hypertrophy and ligamentum flavum thickening. Mild bulging disk. Mild effacement of the ventral thecal sac. No significant generalized spinal canal stenosis. Mild bilateral foraminal narrowing. L4-5: Hypertrophy of the residual facets. No significant spinal canal stenosis. No significant foraminal narrowing. Partial laminectomy/facetectomy is suspected at least on the left. L5-S1: Hypertrophy of the residual facets. No significant spinal canal stenosis. No significant bony neuroforaminal narrowing. Partial laminectomy/facetectomy is suspected at least on the right where there does appear to be ill-defined soft tissue within the widened neural foramen. | 1. Expected findings related to posterior instrumented spinal fusion without evidence of complication.2. No areas of high-grade spinal canal or neuroforaminal stenosis are suspected within the limitations of CT. At most, there is ill-defined soft tissue within the surgically widened right L5-S1 neural foramen which is entirely nonspecific and may represent postoperative scarring. |
Generate impression based on findings. | Daytime sweats. Screening for lung cancer. LUNGS AND PLEURA: No pleural fluid or pneumothorax. No suspicious pulmonary nodules or masses.Few scattered foci of distal bronchiolar impaction/debris within the right upper lobe (series 5 images 56 and 50) which are unlikely to be of clinical significance.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy. Mild coronary artery calcifications. Normal heart size.CHEST WALL: 2-3 mm calcification in the right breast is nonspecific by CT and may be correlated with mammography if not performed within the last year.Small calcification in the right thyroid gland (3/4), also nonspecific by CT.No chest wall lymphadenopathy.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Gastric staple line. | No signs of neoplasm or other acute abnormality. Mild coronary artery calcification. Nonspecific calcifications in the thyroid gland and right breast. |
Generate impression based on findings. | 66 years old male with a history of non-small cell lung cancer, status-post chemoradiation on the 11/2013. This study was performed for restaging.RADIOPHARMACEUTICAL: 15.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 121 mg/dL. Today's CT portion grossly demonstrates a large right pleural refusion with collapse of the right lung. The small right pneumothorax. A chest tube is seen in with its tip in the pleural effusion. Multiple mildly enlarged lymph nodes are seen in the mediastinal paratracheal region and subcarinal region. There is an obstruction of the right main bronchus. Today's PET examination demonstrates diffuse and mild FDG uptake in the right pleura involving the whole right hemithorax with SUVmax of 5.6. There is diffuse and uniformly increased FDG activity in the collapsed right lung with SUVmax of 7.1. Mild to moderate FDG uptake is seen in the multiple mildly enlarged lymph nodes in the right paratracheal and subcarinal regions and in both lung hila. The SUVmax in the mediastinal subcarinal lymph nodes is 7.1.There is a focus of increased activity in the right parotid gland, corresponding to a soft tissue density seen on CT with a SUVmax is 10.0.Physiological activity is seen in the liver, spleen, kidneys, intestines and bladder. | 1.Diffuse and mildly to moderately increased metabolic activity in the collapsed right lung and right pleura, which can be due to tumor or posttreatment change.2.Mediastinal and hilar lymphadenopathy with mildly to moderately increased metabolic activity, which can be due to tumor or posttherapy change.3.Intense FDG uptake in the soft tissue density in the low portion of the right parotid gland, which can be due to tumor inflammatory change.4.Right large pleural effusion and small right pneumothorax. |
Generate impression based on findings. | 11-year-old male with abdominal pain, poor weight gain, evaluate extent of Crohn's disease.EXAMINATION: MR enterography with and without IV contrast, 2/20/15 14:04 ABDOMEN:LIVER, BILIARY TRACT: Normal hepatic morphology and enhancement without focal lesion. No biliary ductal dilatation.SPLEEN: Normal splenic morphology and enhancement.PANCREAS: No focal pancreatic lesion.ADRENAL GLANDS: Symmetric adrenal glands with normal morphology.KIDNEYS, URETERS: Symmetric renal enhancement without focal lesion. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: There is adequate distention of the stomach, small bowel and proximal colon with oral contrast. No small bowel wall thickening, abnormal enhancement, or focal lesion. The small bowel is normal in caliber. The terminal ileum is patent, without abnormal enhancement. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: The bladder is moderately distended with fluid.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: There is adequate distention of the stomach, small bowel and proximal colon with oral contrast. No small bowel wall thickening, abnormal enhancement, dilatation, or focal lesion. The terminal ileum is patent, without abnormal enhancement. The descending colon and rectum are collapsed and not well evaluated.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Normal examination. |
Generate impression based on findings. | Ms. McDonald is a 72 year old female recalled from screening mammogram for calcifications in the left breast. She has a family history of breast cancer in her maternal aunt and cousins. An ML view and two spot magnification views of the left breast 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. There is a small cluster of amorphous calcifications in the central left breast. These can be seen to some degree on prior studies from 2013 and 2011. There are no new masses or areas of architectural distortion in the left breast. | High probability benign cluster of calcifications in the left breast. As long as the patient's physical examination remains normal, left unilateral 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. | 49-year-old female. Cough and wheezing. Shortness of breath. LUNGS AND PLEURA: Mild bronchial wall thickening suggestive of bronchitis or asthma.Basilar linear scarring and/or atelectasis, increased from prior.New fine mild subpleural reticular opacities in the bases, anteriorly and posteriorly, which may represent subpleural edema possibly from lung reexpansion or early fibrosis.No suspicious pulmonary nodules.MEDIASTINUM AND HILA: Normal heart size. Mild anterior pericardial thickening versus small amount of fluid.Mildly enlarged left hilar node that is 11 mm in short axis (series 3, image 46).No visible coronary artery calcification.Nonspecific punctate thyroid calcifications possibly of underlying nodules, new from prior.CHEST WALL: No axillary lymphadenopathy.Mild degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Severe hepatic steatosis. | 1. Mild bronchial wall thickening suggestive of bronchitis or asthma. 2. New mild subpleural reticular opacities in the bases, which may represent subpleural edema or early fibrosis. Further evaluation with dedicated ILD protocol CT is recommended when feasible.3. Nonspecific mildly enlarged left hilar lymph node, which may be reactive.4. New punctate calcifications in the thyroid, possibly of underlying nodules, nonspecific; further evaluation with thyroid US as clinically warranted. |
Generate impression based on findings. | 2-year-old male with swelling and tenderness after jumping off of bedVIEWS: Right elbow, AP, oblique, and lateral (3 views) 2/20/15 15:19 Moderate joint effusion. Subtle supracondylar lucency consistent with a supracondylar fracture. | Supracondylar fracture and joint effusion. |
Generate impression based on findings. | 5-year-old female needs evaluation of wrist size.VIEWS: Left wrist AP oblique lateral (3 views) and right wrist AP oblique lateral (3 views), 2/20/2015 at 1452 No acute fracture or dislocation in either wrist. Alignment is anatomic. The wrists appear symmetric. | Normal examination with symmetric right and left wrists. |
Generate impression based on findings. | Lung cancer chemotherapy follow-up. Status post 14 cycles of MPDL3280A. LUNGS AND PLEURA: Right upper lobe mass (5/35) measures 4.2 x 1.3 cm, previously 4.6 x 1.3 cm.Right middle lobe mass at the reference level now appears distinct from adjacent subpleural scar, measuring 12 x 14 mm in its posterior component and 8 millimeter in the anterior component (5/49), previously measuring 2 x 1.4 cm. On the soft tissue windows the necrotic component measures 11 x 8 mm, previously 10 x 8 mm (4/49).Scattered nonspecific micronodules too small to characterize and may be followed on subsequent exams, possibly post inflammatory. Post therapeutic changes related to radiation.MEDIASTINUM AND HILA: Low density centrally necrotic conglomerate lymphadenopathy in the prevascular region measures 32 x 22 mm, previously 27 x 23-mm (4/24). However, the lymph node subjectively appears smaller and the measurement change is most likely caused by distortion of the mediastinum by phrenic nerve paralysis. On the coronal series the lesion has decreased in craniocaudal length, 15-mm compared to 18-mm previously (coronal image 50). Small hypoattenuating lymph nodes in the hila bilaterally unchanged (4/42).Small volume of pericardial fluid. Hiatal hernia. Paracaval lipoma. Right tracheoesophageal lesion measures 1.5 x 2 cm, previously 1.4 x 2.1 cm, not significantly changed since the patient's initial study of 4/29/2003 and on each study has been isoattenuating with the thyroid gland, most likely a benign ectopic focus of thyroid tissue.CHEST WALL: Right low cervical lymphadenopathy, please refer to separately reported neck CT. T12 superior endplate collapse. Degenerative changes of the spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Limited scanning range. The cystlike hypoattenuating lesions in liver are unchanged and probably benign.Elevation of the left hemidiaphragm is new, causing decrease in left lung volume and mild distortion of the mediastinum. | Interval development of left phrenic nerve paralysis due to the necrotic left anterior mediastinal mass. As a result, the transaxial dimensions of the lesion are not comparable to the previous studies. Subjectively and when measured in craniocaudal length, the lesion has overall slightly decreased in size. Additional lesions not significantly changed as described in the body of the report. |
Generate impression based on findings. | Medulloblastoma undergoing STC workup. Please evaluate GFR prior as part of pre-transplant workup. The patient’s weight of 11.4 kg and height of 90 cm were used for all calculations.Raw GFR = 42 mL/minBSA = 0.5577 m2Estimated GFR/m2 = 76 mL/min/m2Estimated GFR/m2 * 1.73 m2 (average adult BSA) = 131 mL/min (adult GFR equivalent) | GFR measurements as above. |
Generate impression based on findings. | Pedestrian versus automobile. Ankle swelling and tenderness to palpation over the lateral malleolus. Vertically oriented nondisplaced fracture through the medial malleolus. The ankle mortise appears intact. No fibular fracture is evident in the imaged distal fibula. | Medial malleolar fracture, as above. Dedicated tibia/fibula radiographs should be considered to evaluate for a proximal fibular fracture. |
Generate impression based on findings. | Tremor hands, head, mouth. Possible Parkinson's disease, tremor is increasing. There is slightly decreased activity within the right putamen compared to the contralateral side. | Slightly decreased activity within the right putamen; clinical correlation is suggested. |
Generate impression based on findings. | 2-year-old male with medulloblastoma, status post craniotomy and induction chemotherapy, assess disease status CHEST:LUNGS AND PLEURA: No nodules or masses. Evaluation of the lung bases is limited due to motion artifact. Note is made of an azygous pseudo-lobe. Mild basilar atelectasis.MEDIASTINUM AND HILA: Right central venous catheter extends to the cavoatrial junction. No mediastinal or hilar lymphadenopathy. The heart size is normal.CHEST WALL: No axillary or supraclavicular lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: Normal hepatic morphology. No biliary ductal dilatation.SPLEEN: No focal splenic lesion.PANCREAS: Normal pancreatic morphology.ADRENAL GLANDS: Bilateral adrenal glands are normal.KIDNEYS, URETERS: Symmetric renal cortical enhancement and contrast excretion without hydronephrosis.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: The bowel is normal in caliber.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Distended without abnormality. LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: The bowel is normal in caliber.BONES, SOFT TISSUES: Note is made of bone marrow biopsy tract. OTHER: Small calcification adjacent to the distal lumbar spinal cord of unclear etiology. | No evidence of metastatic disease in the chest, abdomen or pelvis. Small focus of calcification adjacent to the distal lumbar spinal canal of uncertain significance. |
Generate impression based on findings. | 70 years, Female. Reason: constipation History: abdominal pain Nonobstructive bowel gas pattern with less than average stool burden in the colon. Dense vascular calcifications are noted. | Nonobstructive bowel gas pattern with less than average stool burden in the colon. |
Generate impression based on findings. | 86 years, Male. Reason: Rule out obstruction History: pain and constipation along with belching Mildly distended loops of small bowel in the abdomen and air in the rectum. Degenerative arthritic changes in the bones and a total right hip arthroplasty is noted. | Mildly distended loops of small bowel and air in the rectum may represent partial small bowel obstruction versus ileus. |
Generate impression based on findings. | 70 years, Male. Reason: DHT placement History: DHT placement Enteric feeding tube tip projects over the distal gastric body. Nonobstructive bowel gas pattern. The pelvis is excluded from the field-of-view. | Enteric feeding tube tip projects over the distal gastric body. |
Generate impression based on findings. | 79-year-old male with newly diagnosed lung cancer, evaluate for brain metastases There are no intracranial enhancing foci to suggest the presence of metastatic disease. No intracranial hemorrhage, mass, mass effect, midline shift is identified. Gray-white differentiation is maintained. Sulci and ventricles are within normal limits for age without evidence of hydrocephalus. No extra-axial collections. There are are scattered areas of hypoattenuation in the periventricular and subcortical white matter which appears stable. A small right maxillary mucous retention cyst is again noted. Fluid is noted within a few bilateral dependent mastoid air cells, unchanged. | There are no intracranial enhancing foci to suggest the presence of metastatic disease. |
Generate impression based on findings. | Prolonged SOB and cough with left chest pain. PULMONARY ARTERIES: No evidence of pulmonary embolism.LUNGS AND PLEURA: Mild bronchial wall thickening suggestive of bronchitis or asthma.Left lower lobe focal consolidation extending to the pleural surface with adjacent tree-in-bud opacities consistent with pneumonia.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Normal heart size without pericardial effusion. No visible coronary artery calcification.Residual thymic tissue in the anterior mediastinum.Nonspecific small hypodense left thyroid nodule.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of pulmonary embolism. Left lower lobe pneumonia.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Preop left total hip arthroplasty. Pain. Near severe osteoarthritis affects the left hip with joint space narrowing and bulky osteophytes.The soft tissues of the left hip are otherwise unremarkable. The visualized intra-abdominal contents are unremarkable. | Near severe left hip osteoarthritis. |
Generate impression based on findings. | Male 71 years old Reason: please evaluate for source of infection History: sepsis in VAD pt with recent E.coli pneumonia CHEST:LUNGS AND PLEURA: Interval development of interlobular septal thickening superimposed on ground glass opacities within the left upper lobe, lingula, and left lower lobe (series 5, image 57). Improved small bilateral pleural effusions with overlying atelectasis.MEDIASTINUM AND HILA: Resolution of prior pneumomediastinum with residual loculated fluid in the anterior mediastinum. Stable mediastinal lymphadenopathy. Reference right precarinal lymph node measures 12 mm (series 3, image 43), previously 13 mm. Interval removal of enteric tube. Heart size at the upper limit of normal. Severe coronary artery calcifications. The pulmonary artery is enlarged measuring up to 38 mm, suggestive of pulmonary arterial hypertension. LVAD in place.CHEST WALL: Postsurgical changes of sternotomy. LVAD driveline appears intact without soft tissue fluid collection or abscess.ABDOMEN: The exam is suboptimal secondary to beam hardening artifact from the LVAD obscuring abdominal viscera. LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: The pancreas is nearly completely obscured by beam hardening artifact.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonobstructing right renal calculus. Stable hypodense lesion in the upper pole of the right kidney likely represents a simple cyst.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta and its branches. Ectatic infrarenal abdominal aorta with fusiform shape measuring up to 2.7 cm.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of the spine. | 1.Interval development of ground glass opacities with associated septal thickening involving portions of left upper lobe, lingula and left lower lobe, findings may be secondary to infection/organizing pneumonia particularly given pt's reported history of sepsis, other differential considerations include edema or sequela of aspiration/hemorrhage.2.Improved pleural effusions bilaterally.3.Stable mediastinal lymphadenopathy. |
Generate impression based on findings. | Newly diagnosed lung cancer. Initial staging.RADIOPHARMACEUTICAL: 11.3 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 110 mg/dL. Today's CT portion of the neck demonstrates a linear filling defect within the right internal jugular vein which appears to be adherent to the wall inferiorly and is non-obstructive. Please see diagnostic CT reports for details of the chest, abdomen, and pelvis.Today's PET examination demonstrates a markedly hypermetabolic left upper lobe mass (max SUV = 16.5). No FDG avid tumor is identified in the mediastinum or bilateral hila. No suspicious FDG avid lesions are identified in the neck, abdomen, or pelvis. Focal activity within the left hamstring tendon near the left ischium most likely represents inflammation, possibly from tendinitis. Focal activity near the right great trochanter may represent bursitis or tendinitis. | 1.Markedly hypermetabolic left upper lobe mass consistent with non-small cell lung cancer. No evidence of locoregional or distant FDG avid metastases. 2.Non-obstructive, linear filling defect within the right internal jugular vein is suspicious for subacute thrombus. Finding discussed with Dr Villaflor via telephone at 1622 hrs on 2/20/2015.Diagnostic CTs of the chest, abdomen, and pelvis also performed at today's visit will be reported separately. |
Generate impression based on findings. | Male 26 years old Reason: left elbow pain History: left elbow pain. No acute fracture or dislocation. No definite joint effusion. | No acute fracture or dislocation. |
Generate impression based on findings. | 71 years, Female, Reason: gross hematuria, recurrent UTI History: gross hematuria. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Right hepatic cyst. Subcentimeter foci in the left hepatic lobe are too small to characterize. SPLEEN: Subcentimeter splenic hypodensity is nonspecific.PANCREAS: Main pancreatic duct is normal in caliber. There are 3 nonenhancing hypodensities within the pancreatic body, the largest measuring up to 1.4 x 0.7 cm (3/50).ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No renal stones. No hydronephrosis. No ureteral lesions on delayed phase images. No suspicious renal masses.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative changes of the spine. Hyperdense material in the L4-L5 and L5-S1 disk space.OTHER: Fatty lesion in the right chest subcutaneous tissues is incompletely visualized, possibly representing fat necrosis.PELVIS: FemaleUTERUS, 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. | 1.No findings to explain patient's symptoms.2.Three pancreatic hypodensities with normal appearing pancreatic duct. Recommend MRCP for further evaluation. |
Generate impression based on findings. | Male 67 years old Reason: 67yr old male with history of MM; pre-auto sct evalution History: evaluate. SKULL: Mottled appearance along the posterior skull is suspicious for myelomatous lesions.CERVICAL SPINE: Straightening of the cervical spine with moderate degenerative changes, most prominent at C5/C6. No discrete myelomatous lesions are identified.THORACIC SPINE: Severe compression fracture of what appears to be T6. No discrete myelomatous lesions are identified. LUMBAR SPINE: There is demineralization of the bones with moderate degenerative changes, most pronounced at L5/S1. No discrete myelomatous lesions. RIBS: Possible lytic lesion seen within the right 8th rib. PELVIS: Moderate degenerative changes of the bilateral hips. No discrete myelomatous lesions are identified.UPPER EXTREMITY: Lytic lesions are seen in the right radial mid-diaphysis and left proximal humeral head.LOWER EXTREMITY: No discrete myelomatous lesions are seen in the bilateral proximal and distal lower extremities. | Lytic lesions within the skull, ribs, right radius and left humerus as described above are suspicious for myelomatous depositions. |
Generate impression based on findings. | History of PE, recent surgery, desaturation. PULMONARY ARTERIES: No evidence of pulmonary embolism to the segmental level.LUNGS AND PLEURA: Very small pleural effusions, greater on the left.Endoluminal debris in the trachea and mainstem bronchi as well as scattered impaction of segmental bronchi.Significant atelectasis of the basilar segments of the lower lobes and patchy ground-glass opacities in the dependent right lung due to aspiration.MEDIASTINUM AND HILA: Post surgical findings of recent thymoma resection with small amount of anterior pneumomediastinum and communication of of the bilateral pleural spaces anteriorly.Small bilateral pneumothoraces. Severe coronary artery calcification. Very small pericardial effusion.No mediastinal or hilar lymphadenopathy.Large hiatal hernia. Patulous fluid filled esophagus.CHEST WALL: Large amount of subcutaneous emphysema in the right chest wall.Severe scoliosis and degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Cholelithiasis. Nonobstructive left renal stone. Atherosclerotic calcification of the abdominal aorta and its branches. | 1. No evidence of pulmonary embolism to the segmental level. 2. Significant basilar atelectasis and patchy groundglass opacities in the dependent right lung related to aspiration. Fluid filled patulous esophagus makes patient at risk for continued aspiration.3. Very small bilateral pleural effusions.4. Post-operative changes of thymoma resection with small amount of anterior pneumomediastinum and small pneumothoraces.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Pleuritic chest pain. PULMONARY ARTERIES: Technically diagnostic quality examination. No evidence of pulmonary embolus. LUNGS AND PLEURA: Clustered areas of emphysema-like cystic lung disease with sparing of the lung periphery. This may represent an atypical manifestation of pulmonary histiocytosis or lymphocytic interstitial pneumonitis in the appropriate clinical context, however the intervening lung appears normal.No pneumothorax or pleural fluid.MEDIASTINUM AND HILA: A mildly enlarged right hilar lymph node measures 14-mm (7/120). Normal heart size. No pericardial fluid.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | No evidence of pulmonary embolus. Cystic lung disease atypical for the patient's age which may represent an atypical manifestation of pulmonary histiocytosis or lymphocytic interstitial pneumonitis in the appropriate clinical context. Consider pulmonary medicine consultation.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 79 years, Male, Reason: new head\T\neck ca wiht lung lesion, please stage History: Squamous cell carcinoma of the vocal cord For findings in the neck, please see dedicated neck CT performed on the same day.CHEST:LUNGS AND PLEURA: Left upper lobe mass is increased in size measuring 3.2 x 2.6 cm (4/35), previously 2.7 x 2.2 cm.MEDIASTINUM AND HILA: Severe atherosclerotic calcifications of the aorta and its branches. Cardiomegaly. Moderate coronary artery calcifications.CHEST WALL: Bilateral enlarged axillary lymph nodes with fatty hilum are unchanged. These are hypometabolic on recent PET/CT.ABDOMEN:LIVER, BILIARY TRACT: Right renal hypodensity is too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: Pancreatic tail is atrophic. There is a calcification in the tail with dilatation of the duct distally measuring up to 1.4 cm.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Innumerable renal hypodensities including a large right upper pole hypodensity which is higher attenuation than water. Many of these densities are too small to characterize.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic calcifications of the aorta and its branches with areas of mural thrombus.BOWEL, MESENTERY: Mild degenerative the spine. Nonspecific sclerotic focus in the left T8 posterior rib.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: Enlarged prostateBLADDER: No significant abnormality noted.LYMPH NODES: Enlarged bilateral inguinal lymph nodes including left inguinal node measuring 1.8 x 1.4 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Lucencies within L3 and L2 have well-defined sclerotic borders and likely represent Schmorl's nodes.OTHER: Free fluid in the pelvis is abnormal for a male. | 1.Left upper lobe mass is increased in size.2.Nonspecific inguinal lymphadenopathy.3.Calcification of the distal pancreas with focal dilatation of the pancreatic duct. This may represent chronic pancreatitis, although a main duct IPMN cannot be excluded. Recommend MRCP for further evaluation. |
Generate impression based on findings. | Male, 68 years old, with history of glottic cancer, restaging exam post treatment. The mucosa of the supraglottic larynx is mildly edematous and shows a patchy hyperemic appearance similar to prior. No definite mass is seen. Irregularity at the level of the glottis is nonspecific but potentially related to therapy.No pathologic adenopathy is detected by size criteria. The salivary glands and thyroid are free of focal lesions. Atherosclerotic calcification is evident at the carotid bifurcations. A right upper lobe nodule is better assessed on dedicated chest CT. The airway is patent with a small focus of thickening along the right aspect of the trachea just above the carina which likely represents aspirated debris or secretions. The osseous structures are intact. No suspicious lesions are seen. The left frontal sinus is opacified and there is patchy mucosal thickening through the left ethmoid air cells. | Treatment related findings without evidence of locally recurrent tumor or pathologic adenopathy. |
Generate impression based on findings. | Female 30 years old Reason: evaluate for acute appendicitis History: abdominal pain/guarding ABDOMEN:LUNG BASES: No focal consolidation or pleural effusions.LIVER, BILIARY TRACT: Lobulated, septated fluid containing structure in the right upper quadrant which is likely separate from the focal colitis, see below (series 8028, image 54). Benign etiology is favored such as lymphangioma or duplication cyst.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 focal inflammation and fat stranding adjacent to the the hepatic flexure likely secondary to focal colitis (series 3, image 53). The appendix is not definitively visualized, however, there is a tubular structure in the right lower quadrant (series 3, image 80) which could represent a normal-sized appendix. There are no secondary signs of appendicitis.No pneumatosis or intraperitoneal free air. No evidence of abscess.PELVIS:UTERUS, ADNEXA: Intrauterine device in place.BLADDER: No significant abnormality notedBOWEL, MESENTERY: Mild small bowel wall thickening in the pelvis likely reactive in etiology.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Mild pelvic ascites. | 1.Findings consistent with focal colitis in the hepatic flexure. No pneumatosis or intraperitoneal free air. No evidence of abscess.2.Lobulated, septated fluid containing structure in the right upper quadrant which is likely unrelated to the focal colitis. Favor benign etiology such as lymphangioma or duplication cyst.The findings were discussed by telephone with the emergency room physician, Dr. Chi, at 4:40 p.m. on 2/20/2015. |
Generate impression based on findings. | 70 year-old male with history of abnormal MRI suspicious for carotid artery and jugular vein irregularities. Head without contrast: There is no acute intracranial hemorrhage. Mild periventricular white matter hypoattenuation compatible with age indeterminate small vessel ischemic disease. The gray-white differentiation is preserved. There is no midline shift or mass effect. The basal cisterns are intact. The ventricles and sulci are symmetric. The imaged paranasal sinuses and mastoid air cells are near. The orbits are unremarkable. The calvarium and soft tissues of the scalp are within normal limits.Angiogram/delayed: There is a normal configuration of the aortic arch. The origin of the brachiocephalic, left common carotid, subclavian, and vertebral arteries is normal. There is no abnormal plaque formation at the carotid bifurcation as suggested on prior MRI. There is no evidence of flow-limiting stenosis or aneurysmal dilatation. The anterior commuting artery is intact without evidence of aneurysm. The posterior communicating arteries are intact. There is an AICA/PICA complex present bilaterally. The basilar artery is normal without evidence of aneurysm or stenosis.On delayed imaging, there is a large irregular filling defect within the right internal jugular vein at the level of the hyoid bone measuring approximately 28 x 8 mm in the coronal dimension compatible with thrombus. There are additional foci of thrombus superiorly within the internal jugular vein and at the jugular bulb. The dural venous sinuses appear unaffected. | 1.Intermittent multifocal thrombi within the right internal jugular vein with the largest clot burden located at the level of the hyoid bone. The dural venous sinuses appear unaffected.2.No evidence of carotid artery stenosis as clinically queried.3.Mild age-indeterminant small vessel ischemic disease. |
Generate impression based on findings. | 14 month old male with history of fever.VIEW: Chest and abdomen AP (two views) 2/20/2015 at 1555 Chest: Unchanged cardiothymic silhouette. Sternal wires and bifid right 11th and 12th ribs are again noted. No focal airspace opacity, pleural effusion, or pneumothorax.Abdomen: Gastrostomy tube in place. Nonobstructive bowel gas pattern. No pneumatosis, free air, or portal venous gas. Abdominal surgical sutures are present. | No specific evidence of pneumonia. Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 17 year-old female, assess for AVNVIEW: Pelvis, AP and frog leg (two views) 2/20/15 15:51 The femoral heads are well directed within the normally formed acetabula. No evidence of AVN. The osseous structures of the pelvis appear normal for the patient's age. | Normal examination without radiographic evidence of AVN. |
Generate impression based on findings. | 29 year old man with RV dysfunction referred to rule out cardiac shuntCPT: 75572 Left Ventricle: The left ventricle is severely hypertrophied.Right Ventricle: The right ventricle is severely dilated. Atria: The left atrium is mildly dilated. There is no evidence of left atrial appendage thrombus. All 4 pulmonary veins drain normally into the left atrium. The right atrium is severely dilated. The superior and inferior vena cavae are dilate. The coronary sinus is mildly dilated. A prominent hemi-azygous vein drains into the innominate vein. A small secundum type atrial septal defect or a large patent foramen ovale is noted (3mm). Aortic Valve: The aortic valve is trileaflet and without calcification.Mitral Valve: No mitral valve calcification is noted. Great vessels: The thoracic aorta demonstrates no evidence of dissection or aneurysm. The main and branch pulmonary arteries are mildly dilated.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Coronary arteries: Because heart rate management was not attempted and nitroglycerine was not administered, this exam was not performed to optimally visualize the coronary arteries. However within the limitations of the study the following observations are made: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. No coronary calcium is noted. LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. No coronary calcium is noted.LCx: The left circumflex coronary artery is dominant and courses normally in the the left AV groove. It gives rise to the obtuse marginal branches, posterior descending artery, and posterolateral branches. No coronary calcium is noted.RCA: The right coronary artery arises normally from the right sinus of Valsalva. It is non-dominant coronary artery. No coronary calcium is noted. | 1. Severe left ventricular hypertrophy with mild left atrial dilation. 2. Severe right ventricular dilation with severe right atrial dilation. 3. A small atrial septal defect or a large patent foramen ovale is noted. 4. Normal pulmonary venous drainage. 5. Mild dilation of the pulmonary arteries. 6. Normal origin of the coronary arteries without evidence of coronary calcification. 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. | Male 55 years old Reason: s/p R 1st ray amputation, concern for infection/osteo History: open wound, erythema. Status post first ray amputation. There is a superficial soft tissue defect. There is cortical disruption of the first metatarsal osteotomy and medial surface of the second proximal phalanx compatible with osteomyelitis. | Postoperative changes of the first metatarsal with osteomyelitis as described above. |
Generate impression based on findings. | CAD status post recent DES placement for severe CAD. Patient with new chest pain and DOE. LHC 2/20 shows patent stents but elevated PA pressures. Question of PE as etiology of symptoms. The comparison chest radiograph performed on 2/19/2015 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 left lung during the wash-out phase. The perfusion images demonstrate a single small unmatched perfusion defect of the right apex. There are no moderate, large, or segmental matched perfusion defects. | Low probability of pulmonary embolus. |
Generate impression based on findings. | Reason: head and neck cancer evaluate for treatment. History: as above CHEST:LUNGS AND PLEURA: Several calcified granulomata are present, but there is no evidence of pulmonary or pleural metastases.MEDIASTINUM AND HILA: Mild symmetric thyroid enlargement.No mediastinal or hilar lymphadenopathy although there are calcified nodes from healed granulomatous infection.Severe coronary artery calcifications are present, but the heart and pericardium are otherwise unremarkable in appearance.CHEST WALL: Degenerative abnormalities affect the thoracolumbar spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Unremarkable appearing liver, but there is extensive cholelithiasis. There is no evidence of cholecystitis.SPLEEN: Splenic granulomata.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple renal cystlike hypodensities, likely benign.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. No evidence of metastases.2. Extensive cholelithiasis without cholecystitis.3. Severe coronary artery calcifications. |
Generate impression based on findings. | 35-year-old male with history of trauma. Head: No evidence of acute intracranial hemorrhage. The gray-white differentiation is preserved. No midline shift or mass effect. The basal cisterns are intact. The ventricles and sulci are symmetric. The mastoids are clear. The orbits are intact. The calvarium and soft tissues of the scalp are within normal limits.Maxillofacial: There is no evidence of acute maxillofacial fracture. There are bilateral maxillary antrostomies. There is a minimal amount of debris within the maxillary and ethmoid sinuses. The frontal and sphenoid sinuses are clear. The temporomandibular joints are aligned. The orbits are unremarkable. The lamina papyracea are intact. There is slight leftward deviation of the nasal septum. | No evidence of acute intracranial hemorrhage or maxillofacial fracture. |
Generate impression based on findings. | Assess prosthesis. Left acromion fracture. Left reverse total shoulder arthroplasty device situated in near-anatomic alignment, without evidence of hardware complication. Unchanged suspected left acromion fracture. Interstitial changes are again noted in the left lung. | Left total shoulder arthroplasty, as above. |
Generate impression based on findings. | Fell 1 week ago. Persistent pain in the palm. No fracture or malalignment. Minimal - degenerative changes are present in the basilar joint. Note is made of an ulnar minus variance. | No fracture or malalignment. |
Generate impression based on findings. | postop follow up after right frontal meningioma surgery There is evidence of right fronto-parietal craniotmy with post resection status of the tumor on the right frontal lobe. Most of tumor has been resected, but there is about 7mm thickness x 20mm length dural thickening with enhancement which most likely imply postoperative changes or residual mass less likely. Follow up imaging is recommended.There is about 13mm x 9mm sized well enhancing extra axial calcified mass attached to the right side of falx indicating residual tumor on the right parietal lobe superior lobule.Subtle mass effects with midline shift toward left side is not seen anymore.Parenchymal edema around the tumor area is still seen, no change since prior exam.There is no evidence of parenchymal hemorrhage or ischemic lesion.Subcutaneous calcified mass likely represent sebaceous cysts. | Postop status (near total or total resection of right frontal lobe meningioma)7mm x 20mm sized dural thickening with enhancement on operation site likely representing postoperative changes.Right parietal meningioma and subcutaneous sebaceous cysts, no change since prior exam. |
Generate impression based on findings. | Female 56 years old Reason: evaluate generalized abdominal pain History: pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver. No focal liver lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal stones without evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: 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 | Left nephrolithiasis without evidence of hydronephrosis.Diffuse fatty infiltration of liver. |
Generate impression based on findings. | Right hemiarthroplasty Two views of the right hip demonstrate hardware components of the right hip hemiarthroplasty device situated in near-anatomic alignment, without radiographic evidence of hardware complication. Skin staples and soft tissue gas reflect recent surgery. | Right hip hemiarthroplasty, as above. |
Generate impression based on findings. | 89-year-old female with history of CVA. There is no evidence of acute intracranial hemorrhage. Moderate periventricular and subcortical white matter hypoattenuation compatible with chronic small vessel ischemic disease. Tiny hypoattenuating foci in the basal ganglia compatible with chronic lacunar infarcts. The gray-white differentiation is preserved. The ventricles and sulci are symmetric. The basal cisterns are intact. The visualized paranasal sinuses and mastoid air cells are clear. The calvarium and soft tissues of the scalp are normal. | 1. No acute intracranial abnormality. Please note that CT is insensitive for the detection of an acute ischemic infarct. If patient care warrants further imaging, an MRI may be obtained.2. Moderate chronic small vessel ischemic disease. |
Generate impression based on findings. | 74 year old woman with possible anomalous right coronary artery. She is referred for further evaluation.CPT Code: 75574 Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of Valsalva and trifurcates into the left anterior descending, ramus intermedius, 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 is mild calcification in the proximal and mid LAD, without evidence of significant stenosis. The distal LAD is not well visualized.LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left AV groove. It gives rise to the obtuse marginal branches. There are no significant stenoses in the proximal or mid LCx. There is mild calcification in the mid vessel. There distal vessel is not well seen. RCA: The right coronary artery is large and arises anomalous from the left sinus of Valsalva. At it's origin, there is an acute bend. It takes an intra-arterial course, and there appears to be extrinsic compression of the proximal part of the vessel as it travels in between the aorta and pulmonary artery. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There are no significant stenoses in the right coronary artery. The posterolateral branch is small but appears to have a 50% stenosis in the proximal portion of the segment.Left Ventricle: The left ventricle is mildly dilated. There is no evidence of resting myocardial perfusion defect.Right Ventricle: The right ventricle is mild to moderately dilated.Left Atrium: The left atrium is mild to moderately dilated. 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 atrium is 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. There is mild calcification of the aortic root. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion. | 1. Anomalous origin of the right coronary artery with an intra-arterial course. The vessel is acutely angled at its origin and appears to be moderately compressed by the aorta and pulmonary artery. There is no associated resting myocardial perfusion defect noted. 2. Non-obstructive coronary atherosclerosis. The distal vessels are not well seen. 3. Mild LV and LA dilation. 4. Moderate RV dilation and mild RA dilation. 5. Mild dilation of the main pulmonary artery. 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. | 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. | 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 few circumscribed benign masses 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: 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. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. A biopsy clip is present in the left upper outer quadrant. 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. | 59 year old man referred for assessment of coronary calcification for further risk stratification.CPT: 75571 Calcium Score:LM: 0LAD: 0LCx: 0RCA: 0Total: 0.Coronary anatomy: 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. LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove.LCx: The left circumflex coronary artery courses normally in the left AV groove.RCA: The right coronary artery is large and arises normally from the right sinus of Valsalva.Left Ventricle: Assessment limited due to absence of contrast. LV size appears to be normal.Right Ventricle: Assessment limited due to absence of contrast. RV size appears to be normal.Left Atrium: Assessment limited due to absence of contrast. The left atrium appears to be normal in size. There are four distinct pulmonary veins which drain normally into the left atrium. Right atrium, vena cavae, and coronary sinus: Assessment limited due to absence of contrast. The right atrium appears to be normal in size. SVC, IVC, and coronary sinus appear to drain normally into right atrium.Valves: There is no calcification on the aortic valve. There is no calcification on the mitral valve.Great vessels: The ascending aorta is mildly dilated (39mm). The aortic arch is not seen. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. | 1.Patient has no coronary artery calcification.2. His ascending aorta is mildly dilated.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. | Lateral malleoli are pain and swelling, hit by car Foot: Mild osteoarthritic changes of the first MTP without additional acute abnormality. Soft tissue and alignment otherwise preserved. Hindfoot specifically appears normal.Lower leg: Soft tissue swelling overlying the lateral malleolus with an associated vertical lucency in the irregularity through the medial malleolus. A questionable old partially healed medial malleolus fracture is suspected, please correlate with patient history. No overlying soft tissue swelling and the mortise is intact. There is however a small punctate calcification underlying the fibula, possibly representing again acute or remote ligamentous injury. | Old subacute medial malleolus fracture with lateral soft tissue swelling. Questionable minimal irregularity underlying the distal fibula, ligamentous injury cannot be excluded |
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