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Generate impression based on findings. | 48 year old man being considered for mitral valve surgery. He is referred to rule out obstructive coronary artery disease prior to surgery.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. There is minimal calcification in the distal vessel.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There are no significant stenoses in the LAD. The distal LAD is small and not apex forming.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 LCx.Ramus: Mild, non-obstructive atherosclerosis in the proximal vessel.RCA: The right coronary artery is large and arises normally from the right sinus of Valsalva. 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 PDA is very large and supplies the inferior apex.Left Ventricle: Normal LV size.Right Ventricle: Normal RV size.Left Atrium: The left atrium is mild to moderately dilated. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume appears to be normal in size. 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. The posterior mitral leaflet prolapses into the left atrium. Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not seen. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion. | 1.There are no significant coronary artery stenoses present. 2. Mild coronary atherosclerosis. 3. Mitral valve prolapse. 4. Mild to moderate left atrial dilation. This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report. |
Generate impression based on findings. | 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 |
Generate impression based on findings. | Fifth metatarsal pain. Check for fracture unable to bear weight Mild degenerative changes involving the medial malleolus, compatible with old remote injury. No significant soft tissue swelling or underlying acute osseous abnormality. Specifically the visualized portions of the mid foot and base of fifth metatarsal appear intact. Depending on patient's point of pain, consider dedicated foot imaging | Mild degenerative changes without acute abnormality |
Generate impression based on findings. | Coccyx pain. Patient with a history of Behcets Posterior fixation and fusion of the L5-S1 level without additional acute abnormality. Distal sacrum and coccyx otherwise appear intact and well aligned. SI joints are unremarkable | Fused L5 S1 without superimposed acute abnormalities |
Generate impression based on findings. | Cervical fusion. Follow-up Interval bilateral posterior fixation and laminectomy of C3 through C7. Alignment preserved. Overlying surgical drain. Soft tissues otherwise grossly unremarkable given recent surgery and immediate postsurgical changes | Posterior fixation and laminectomy C3 through C7 |
Generate impression based on findings. | Red and swollen great toe Mild soft tissue swelling is observed without evidence of associated underlying additional abnormality. Specifically osseous structures are intact | Minimal soft tissue swelling without additional focal radiographic abnormality |
Generate impression based on findings. | Shoulder pain, swelling, limited range of motion. Rule out fracture. There is chronic deformity of the proximal humerus consisting of absence of the humeral head and neck with the exception of a 2.5-cm ovoid ossific density projecting lateral to the glenoid fossa. This appears similar to that seen on prior chest radiographs dating back to 2/2014. Deformity of the glenoid likewise appears similar to that seen on prior studies. Small foci of heterotopic mineralization are noted within the soft tissues between the glenoid and remaining proximal humeral diaphysis. I see no acute fracture. | Chronic deformity of the shoulder as described above which may reflect old trauma, prior surgery, or even long-standing atrophic neuropathic arthropathy. I see no acute fracture. |
Generate impression based on findings. | Back pain. Status post fusion. There is a posterior stabilization device with screws entering the L4, L5, and S1 vertebrae. I see no hardware complications. Amorphous bone graft is seen along the lateral aspect of the lower lumbar spine. Gas density within the posterior soft tissues presumably reflects recent surgery. Moderate degenerative disk disease affects L4/5 and L2/3, with relatively mild degenerative disk disease affecting L3/4 and L5/S1. | Postoperative changes of lower lumbar fusion as above. |
Generate impression based on findings. | Crepitus, patellar grind test, effusion. Right knee osteoarthritis? Four views of the right knee are provided. Moderate osteoarthritis affects the knee, particularly the patellofemoral joint, appearing similar to the prior study. There is a moderate to large-sized joint effusion. A small ossicle along the superior aspect of the patella appears similar to that seen on the prior study, of doubtful significance.Mild to moderate osteoarthritis affects the left knee as seen on the frontal view. | Osteoarthritis and joint effusion. |
Generate impression based on findings. | 67 year old woman with atypical chest pain. She is referred to evaluate for obstructive coronary artery disease.CPT Code: 75574 Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There are no significant stenoses present in the left main. There is mild atherosclerosis in the vessel.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There are no significant stenoses in the LAD. The proximal LAD has a partially calcified, non-obstructive plaque resulting in a 25% stenosis. The mid LAD is involved with a myocardial bridge. The distal LAD is free of obvious atherosclerosis. The first diagonal artery is small and likely has a 50-70% intermediate severity stenosis in the proximal portion of the vessel. The second diagonal artery is larger and also has a 50-70% intermediate severity stenosis in the proximal portion of the vessel. 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 LCx. The major obtuse marginal branch has a non-obstructive plaque in the proximal portion.RCA: The right coronary artery is large and arises normally from the right sinus of Valsalva. 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. There is a mild, non-calcified plaque resulting in a <25% stenosis in the proximal portion of the vessel. Left Ventricle: Normal LV size and wall thickness. Right Ventricle: Mild RV dilation. Left Atrium: Grossly normal LA size. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right 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. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion. | 1. There are no significant coronary artery stenoses present in the major coronary arteries. 2. There are stenoses of intermediate severity (50-70%) in the small first diagonal artery branch and in the larger second diagonal artery branch. 3. Mild to moderate burden of overall atherosclerosis. 4. Mild right ventricular and right atrial dilation. This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report. |
Generate impression based on findings. | Female 19 years old Reason: concern for gallstone pancreatitis with intrauterine fetal demise History: nausea/vomiting ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Diffuse fatty infiltration of the liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is mild hydronephrosis involving both kidneys, more prominent on the left compared to the right likely secondary to pregnancy. Bilateral striated nephrogram can be due to hydronephrosis, however, pyelonephritis cannot be excluded.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: Single intrauterine pregnancy. Placenta is anteriorly located and extends to the cervix. Amniotic fluid is decreased. Cervix appears to be open.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of pancreatitis is questioned. Bilateral mild hydronephrosis, more on the left compared to the right likely secondary to gravid uterus. Bilateral striated nephrogram can be due to hydronephrosis however, pyelonephritis cannot be excluded. Correlation with pending urine culture test is recommended.Placenta previa. Oligohydramnios.Dr. Pandia was notified and acknowledged about the above findings at the time of dictation. |
Generate impression based on findings. | Female 86 years old Reason: appy, SBO History: RLQ abd pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Simple cysts in the left lobe of the liver is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Bilateral small adrenal nodules, unchanged.KIDNEYS, URETERS: Bilateral renal cysts are unchanged. Unchanged partially calcified right renal artery aneurysm measuring 1.5 by 1.1 cm on image number 53, series number 3.RETROPERITONEUM, LYMPH NODES: Shotty lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Uterine fibroids, unchanged.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No CT findings to explain patient's abdominal pain. |
Generate impression based on findings. | Female 70 years old Reason: Evidence of mesenteric ischemia - assess SMA History: 70 F vasculopath transfer from OSH with red jelly output from stoma and severe abd pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Nonspecific hypodense lesion in the left lobe of the liver measuring 1.1-cm in diameter, unchanged. Mild fatty infiltration of the liver is unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: 1.1-cm in diameter left adrenal partially calcified nodule likely representing an adenoma, unchanged.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Aortofemoral grafts, patent. Superior mesenteric artery is been stented but is occluded. Severe calcific atherosclerotic disease involves the abdominal aorta and its major branches. There is a significant stenosis at the origin of the celiac trunk. IMA is not visualized. There is also significant atherosclerotic disease at the origin of the bilateral renal arteries, worse on the right side compared to the left. Distal abdominal aorta is occluded. Native common iliac arteries are also occluded.BOWEL, MESENTERY: The right lower quadrant ostomy. There is interval progression in the dilatation dilatation of the proximal small bowel loops measuring up to 4.6 cm. immediately before the colostomy the small bowel loops are collapsed. No evidence of free air to suggest perforation. Small amount of ascites.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: Please see discussion aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Severe atherosclerotic changes as described above. SMA stent is occluded. Significant stenosis at the origin of the celiac trunk and right renal artery. IMA is not visualized.Interval increase in the dilatation of the proximal small bowel loops with decompression of the bowel loops immediately before the right lower quadrant ostomy. These findings be secondary to a obstruction immediately proximal to the ostomy versus a worsening ileus secondary to bowel ischemia. No evidence of free air.Dr. Shogan was notified and acknowledged about the above findings at the time of dictation. |
Generate impression based on findings. | Male 33 years old Reason: s/p creation of colostomy in setting of obstructing rectal cancer History: s/p colostomy Limited study due to delayed phase of imaging.ABDOMEN:LUNG BASES: Large right-sided pleural effusion, decreased compared to previous study. 10 x 9 mm right lower lobe nodule on image number 5, series number 5 suspicious for metastatic disease.LIVER, BILIARY TRACT: Status post right hepatectomy. Again noted grafts in the IVC and hepatic artery. Linear hypodensities at the lateral edge of the anastomosis may represent dilated ducts or small amount of fluid.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral mild hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Significant distention of the entire colonic segments up to the level of the rectal anastomosis. There is significant soft tissue density in the presacral space around anastomoses. There is new small amount of air in the presacral space best seen in image number 100, series number 4. These findings are compatible with a colonic obstruction at the level of the anastomosis and a possible sealed off perforation at the level of the anastomosis, given the interval development of free air in the presacral space.Small amount of free air on the ostomy is likely postsurgical. Small bowel loops are not distended.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Small amount of air in the bladder of unknown etiology.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Interval the locomotive expansile lytic and sclerotic lesion in the left iliac bone measuring 4.3 by 3-cm image number 91, series number 4, suspicious for metastatic disease.OTHER: No significant abnormality noted | Limited study due to delayed phase imaging secondary to scanner malfunction.Colonic obstruction at the level of the rectal anastomosis. Small amount of free air in the presacral space, suspicious for a sealed off perforation around the rectal anastomosis.Left iliac bone lesion and right lower lobe lung lesion suspicious for metastatic disease. These findings were discussed with acknowledged by Dr. Burress at the time of the dictation. |
Generate impression based on findings. | Female 27 years old Reason: 27yo F with h/o ileocolonic Crohn Disease s/p total proctocolectomy and end ileostomy in 2010 with revision in 2011, now 25 weeks pregnant, with h/o recent MSSA bacteremia, presenting with abd pain, N/V, ? obstruction. Pls eval for active disease. History: abdominal pain, stoma prolapse This study is limited due to lack of intravenous contrastABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral mild hydronephrosis secondary to pregnancyRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of small bowel obstruction. There is mild wall thickening involving the small bowel loops proximal to the ostomy, which may be a sign of mild active inflammation.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Single intrauterine pregnancy in vertex position.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of small bowel obstruction. Very mild wall thickening of the small bowel loops proximal to the ostomy which may be associated with mild active inflammation. |
Generate impression based on findings. | Male 59 years old Reason: OG tube placement History: OG tube placement The tip of the enteric tube is coiled in the stomach. Remaining support devices are stable with nonobstructive bowel gas pattern. | No free air. |
Generate impression based on findings. | Female 36 years old Reason: r/o obstruction History: conspitation, abdominal pain, vomiting Nonobstructive bowel gas pattern. No free air. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Female 55 years old Reason: eval for stool burden, free air History: abdominal pain, diarrhea Nonobstructive bowel gas pattern. No free air. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Female 47 years old Reason: Assess stool burden History: Diarrhea, constipation. Nonobstructive bowel gas pattern. No free air. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Male 63 years old Reason: patient with dropping h/h History: dropping HEMOGLOBIN The tip of the enteric tube is in the antrum. Nonobstructive bowel gas pattern. No free air. Multiple patchy opacities in the lungs compatible with pneumonia. | The tip of the enteric tube is in the antrum. Pneumonia. |
Generate impression based on findings. | Female 27 years old Reason: evaluate for cause of abomdinal pain History: diffuse abdominal pain, nausea and diarrhea Nonobstructive bowel gas pattern. No free air. | No free air. |
Generate impression based on findings. | Female 67 years old Reason: bowel obstruction, NGT History: bowel obstruction, NGT The tip of the NGT is in the distal antrum. Nonobstructive bowel gas pattern. No free air. | No free air. |
Generate impression based on findings. | Male 75 years old Reason: eval dobhoff History: s/p ngt placement Nonobstructive bowel gas pattern. No free air. Pelvis is excluded from the x-ray. The tip of the Dobbhoff tube is in the left main bronchus. | The tip of the Dobbhoff tube is in the left main bronchus.Dr. Pabla was notified and acknowledged about the above findings at the time of dictation. |
Generate impression based on findings. | Female 71 years old Reason: history of bladder cancer, not yet resected, evaluated for changes History: bladder cancer ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Mild wall thickening at the dome of the bladder may be compatible with patient's known history of bladder cancer.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Mild wall thickening of the bladder near the dome, can be compatible with patient's known history of bladder cancer. |
Generate impression based on findings. | Male 37 years old Reason: h/o aortic root and valve replacement, follow up examination History: cough CHEST:LUNGS AND PLEURA: New left lower lobe consolidation consistent with pneumonia. Right lower lobe atelectasis, unchanged. New groundglass opacities in the right lower lobe of uncertain etiology and significance. Pneumonia cannot be excluded.MEDIASTINUM AND HILA: Interval replacement of the aortic valve and the aortic root. Right-sided aortic arch configuration. No evidence of dissection. Postsurgical changes secondary to aortic root and bowel are placements. Small mediastinal lymph nodes are unchanged. There is small amount of pericardial fluid extending to the superior epicardial recess. Small amount of air is also present in the superior epicardial recess. The etiology of air is uncertain and may be postsurgical versus infectious.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Mild atherosclerotic changes involving the distal abdominal aorta.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Left lower lobe pneumonia. Possible right lower lobe pneumonia.Interval postsurgical changes involving the aortic root and aortic valve. Small amount of fluid and air around the aortic graft, best seen on image number 77, series number 9. This may be postsurgical versus infectious in etiology. A graft infection cannot be excluded. Correlation with clinical findings is recommended.Dr. Pulimi was notified and acknowledged about the above findings at the time of dictation. |
Generate impression based on findings. | Clinical ABDOMEN:LUNG BASES: Subsegmental atelectasisLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: UnremarkablePANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 2 x 2 cm ill-defined hypodense area associated with perinephric fat stranding in the midportion of the right kidney, best seen image number 64, series number 4 likely represents focal pyelonephritisRETROPERITONEUM, 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: Sclerosis around the bilateral sacroiliac joints may be secondary to sacroiliitis. This has not significantly changed from previous study.OTHER: No significant abnormality noted | Right focal pyelonephritis. Follow-up CT or MR imaging in 6 months may be helpful to confirm resolution of these findings. |
Generate impression based on findings. | Male 53 years old Reason: eval stone History: lower abd pain, vomiting, blood in urine ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate stone in the right kidney, best seen on image number 42, series number 4. No evidence of hydronephrosis. No stones in the left kidney or bilateral ureters.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Right nephrolithiasis without evidence of hydronephrosis. |
Generate impression based on findings. | Male 71 years old Reason: r/o mesenteric ischemia, diverticulitis (GFR too low for contrast) History: abdominal pain, diarrhea, n/v This study is limited due to lack of intravenous contrastABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis without CT evidence of cholecystitisSPLEEN: Moderate splenomegaly.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Diffuse wall thickening involving the distal transverse colon, splenic flexure and entire descending colon consistent with colitis. Etiology is unknown and may be secondary to infectious, inflammatory or ischemic.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Limited study due to lack of intravenous contrast. Diffuse wall thickening of the left-sided colon associated with pericolonic fat stranding is consistent with colitis. Etiology can be infection, inflammation or ischemia.Moderate splenomegaly and significant enlarged prostate gland |
Generate impression based on findings. | Female 70 years old Reason: 70yoF worsening chronic abd pain with hx of abd surgeries (colectomy/colostomy/LOA) History: as above ABDOMEN:LUNG BASES: Mild cardiomegaly. Small amount of pericardial effusion.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: There are significant atherosclerotic changes involving the abdominal aorta and its major branches. Moderate stenosis at the level of the celiac trunk. Near complete occlusion of SMA. IMA is not visualized. Significant stenosis at the origin of the renal arteries.BOWEL, MESENTERY: Colon is not visualized other than the rectosigmoid colon. There is a significantly distended small bowel loop measuring up to 4.6 cm in the right lower quadrant. Small bowel loops distal to this segment in the right lower quadrant are decompressed. These findings may indicate a distal small bowel obstruction, possibly due to adhesions. Ileocolonic anastomosis patent. Sigmoid colon is significantly dilated measuring up to 9.3 cm on the coronal image.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: Please see discussion aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Significant atherosclerotic changes involving the aorta and its major branches including celiac trunk, SMA and IMA and bilateral renal arteries as described above. Based on these findings there is likely chronic mesentery ischemia.Significant dilatation of a small bowel loop in the right lower quadrant with somewhat decompressed more distal loops suggestive of partial obstruction. Rectosigmoid colon is also significantly distended. |
Generate impression based on findings. | Reason: R/o pneumonia, plural effusion History: SOB, desat, fever LUNGS AND PLEURA: An area of consolidation in the lateral portion of the right upper and middle lobes, with surrounding ground glass, is new from the prior exam.Scattered basilar consolidation and groundglass and mild dependent atelectasis.Small to moderate right pleural effusion. No left pleural effusion.Scattered benign appearing micronodules, some calcified. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: The heart is enlarged, without pericardial effusion. Severe coronary artery calcification. AICD leads along the right atrium and left ventricle.A right paratracheal lymph node measures up to 17 mm (series 3, image 42), similar in appearance to the prior exam. Additional scattered mediastinal lymph nodes are not significantly changed.CHEST WALL: Soft tissue mass and adjacent axillary lymphadenopathy along the right lateral chest subcutaneous soft tissue are increased from the prior exam. A prominent nodular component of the mass measures 35 x 26 mm (series 3, image 46). The mass abuts the musculature of the chest wall, without evidence of invasion.Mild degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. A new area of consolidation and ground glass in the lateral portion of the right upper and middle lobes likely represents pneumonia or infarct. Additional basilar consolidation and groundglass likely related to inflammatory process, including aspiration. New right pleural effusion.2. Right lateral chest soft tissue mass and adjacent axillary lymphadenopathy correlate with a known history of melanoma. No evidence of chest wall invasion. |
Generate impression based on findings. | 16-year-old male status post gunshot wound abdomen and laparotomy, now with bilious emesis/ileus. Evaluate for a asbc. ABDOMEN:LUNG BASES: Right middle lobe opacification and bilateral small pleural effusions.LIVER, BILIARY TRACT: Normal appearance with no evidence of intra-or extrahepatic biliary ductal dilatation. Gallbladder is normal. SPLEEN: Accessory spleen is again seen just anterior to the spleen. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Slight interval decrease in the amount of hyperdense material seen along the right paracolic gutter and right retroperitoneum surrounding the right psoas muscle. Previously noted bullet fragment just left to the aorta is no longer seen. BOWEL, MESENTERY: Feeding tube tip in the stomach. Dilated proximal small bowel loops with distal collapsed bowel compatible with obstruction, transition point likely in the left midabdomen (series 4, image 94). Contrast is seen in the ascending and descending colon. No bowel wall thickening, pneumatosis or free air. BONES, SOFT TISSUES: Fracture of the superolateral aspect of the L4 vertebral body as well as the posterosuperior aspect of the right iliac bone is again seen. Previously noted bullet tract is again seen extending from the right back at the level of L4-L5 extending through the right paraspinal and right psoas muscles with decrease in the amount of air and fluid. Bullet fragments are again noted along this tract as well as in the left lower back. OTHER: No significant abnormality noted. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Air in the bladder likely from instrumentation. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small bowel obstruction as described above. Contrast is seen in the ascending and descending colon.BONES, SOFT TISSUES: Fractures of L4 and right iliac bone as noted above. OTHER: Small amount of free fluid in the pelvis. | 1. Findings compatible with small bowel obstruction. 2. Right middle lobe pneumonia with bilateral pleural effusion.3. Minimal interval decrease in right retroperitoneal hematoma. 4. Free fluid in the pelvis likely postoperative in nature. Findings were discussed by on-call Radiology resident Dr. Mikin Patel with Peds surgery fellow Dr. Johnathan at 10:25 PM on 2/20/2015. |
Generate impression based on findings. | ACDF There is an anterior plate with screws entering the C6 and C7 vertebral bodies. I see no hardware complications. Bone graft is situated between the C6 and C7 vertebral bodies. The cervical spine is slightly kyphotic but otherwise alignment is within normal limits. A drain and foci of gas density in the soft tissues reflect recent surgery. | Postoperative changes of ACDF as described above. |
Generate impression based on findings. | Severe neuropathic pain of both distal upper extremities. Evaluate for cervical DJD, spinal canal stenosis, foraminal stenosis. Severe bilateral lower extremity neuropathic pain. Evaluate for lumbar DJD, spinal canal stenosis. Five views of the cervical spine are provided. There is moderate degenerative disk disease at C5/6 with small anterior and posterior vertebral body osteophytes and and mild (grade 1) retrolisthesis of C5. Mild degenerative disk disease affects C6/7. There are minimal (grade 1) retrolistheses of C3 and C4. There is straightening of the cervical spine. There is mild narrowing of the C4/5 neuroforamina on the right. Tension wires affix the sternum. A right-sided central venous access device as well as leads of cardiac conduction device are incompletely imaged on this study.Five views of the lumbar spine are provided. Moderate to severe facet joint osteoarthritis affects the lower lumbar spine, and I suspect that there is narrowing of the neuroforamina at L4/5 and L5/S1. Alignment is within normal limits. The vertebral body heights are preserved. | Degenerative disk disease and other findings as described above. |
Generate impression based on findings. | Reason: eval tumor burden History: facial swelling LUNGS AND PLEURA: Elevated right hemidiaphragm, with associated volume loss.Paramediastinal fibrosis, greater on the right is new from the prior exam, likely related to postradiation changes. Mild basilar subsegmental atelectasis. Scattered nodularity and ground glass at the left lung base (series 6, image 89) likely inflammatory in origin, including aspiration.No pleural effusions.MEDIASTINUM AND HILA: A multilobulated, calcified anterior mediastinal mass with scalloping of the posterior sternum does not appear significantly changed from the prior exam, measuring 8.5 x 2.4 cm (series 4, image 55), compatible with a known history of thymic carcinoma.There is occlusive thrombus in the superior vena cava, with extension into the right brachiocephalic, subclavian, and internal jugular veins, with collateral vessel formation, suggestive of chronicity.Flow within the SVC is reconstituted below the level of the azygous vein. There is a nonocclusive thrombus within this portion of the SVC, extending to the cavoatrial junction.The arterial structures and airways are grossly patent.CHEST WALL: Increased sclerosis in C5 and T4 vertebral bodies, and stable sclerosis at L1, suggesting progression of osseous metastatic disease.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Stable multilobulated, calcified anterior mediastinal mass, compatible with a known history of thymic carcinoma.2. Occlusive thrombus in the superior vena cava, with extension into the right brachiocephalic, subclavian, and internal jugular veins, with collateral vessel formation, suggestive of chronicity.3. Flow within the SVC is reconstituted below the level of the azygous vein. A nonocclusive thrombus within this portion of the SVC, extending to the cavoatrial junction, may represent bland thrombus or tumor thrombus. |
Generate impression based on findings. | Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.Disc desiccation is present at L/5 and L5/S1. Mild disc height loss is evident at L4/5 with advanced disc height loss at L5/S1. These findings are unchanged.T12/L1: Unremarkable and unchangedL1/2: Unremarkable and unchangedL2/3: Unremarkable and unchangedL3/4: Unremarkable and unchangedL4/5: There is a new tiny central midline disc protrusion without significant associated mass effect. There is also superimposed mild disc bulge without central or neural foraminal stenosis.L5/S1: There has been previous right-sided microdiscectomy at this level with removal of previously demonstrated right paracentral disc protrusion. There remains diffuse annular disc bulge with expected mild disc irregularity at the site of the disc protrusion. Additionally, T1 hypointensity associated with enhancement is noted around the right epidural space and surrounding the right S1 nerve root sheath, however without evidence of associated mass effect. Mild bilateral foraminal stenosis is unchanged. | 1.L4/5: There is a new tiny central midline disc protrusion without significant associated mass effect. 2.L5/S1: There has been previous right-sided microdiscectomy at this level with removal of previously demonstrated right paracentral disc protrusion. There remains diffuse annular disc bulge with expected mild disc irregularity at the site of the disc protrusion. Additionally, T1 hypointensity associated with enhancement is noted around the right epidural space and surrounding the right S1 nerve root sheath, however without evidence of associated mass effect. Mild bilateral foraminal stenosis is unchanged. |
Generate impression based on findings. | Male 70 years old; Reason: evaluate for infection/osteo History: pain/bandemia The bones appear slightly demineralized. We see no radiographic findings to suggest osteomyelitis. Mild osteoarthritis affects the foot. | Mild osteoarthritis, without findings to suggest osteomyelitis. |
Generate impression based on findings. | 16-year-old male status post gunshot wound/laparotomy now with fevers, concern for respiratory process.VIEWS: Chest PA/lateral (two views) 2/20/2015 NG tube with side port at the GE junction.Cardiothymic silhouette is normal. Right middle lobe opacity with silhouetting of the right heart border new from prior study. No pleural effusion or pneumothorax. Air-fluid level in the stomach. | 1. Findings most consistent with right middle lobe pneumonia. 2. Feeding tube with side port at the GE junction. |
Generate impression based on findings. | Male 70 years old; Reason: evaluate for fracture/dislocation History: pain and reported fall The bones appear demineralized. Mild osteoarthritis affects the shoulder. We see no fracture or dislocation.A small focus of calcification along the medial aspect of the proximal humeral diaphysis may reflect calcification of a tendinous insertion, of questionable clinical significance. Degenerative arthritic changes are seen in the visualized spine. The lung volumes are low, with subsegmental atelectasis. | Mild osteoarthritis and other findings as described above. We see no fracture or dislocation. |
Generate impression based on findings. | Female 74 years old. Shoulder painful on anterior palpation, unable to move L arm to any significant degree. Central low back pain and b/l lower extremity weakness unable to walk LEFT SHOULDER: Mild osteoarthritis affects the left shoulder. We see no fracture or dislocation. LUMBAR SPINE: The bones are slightly demineralized. Moderate to severe degenerative disk disease affects the lower lumbar spine. Moderate facet joint osteoarthritis affects the lower lumbar spine. The alignment is within normal limits. The vertebral body heights are preserved. There is hypertrophy of the spinous processes with associated degenerative changes. Mild osteoarthritis affects the left hip. | Degenerative changes of the left shoulder and lumbar spine. We see no fracture or dislocation. |
Generate impression based on findings. | No CT evidence of acute large territorial ischemia. No acute intracranial hemorrhage, masses, mass effect or midline shift. Moderate prominence of the ventricles and sulci, likely age related volume loss. Moderate periventricular and subcortical white matter hypoattenuation, likely age indeterminate small vessel ischemic disease. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are clear. | No CT evidence of acute large territorial ischemia. If there is high clinical suspicion for acute ischemia, further evaluation with MRI is recommended. |
Generate impression based on findings. | Reason: does patient have PE History: SOB, tachycardia, Chest pain PULMONARY ARTERIES: No evidence of pulmonary embolism. The main pulmonary artery is upper normal in caliber.LUNGS AND PLEURA: Prominent septal lines. Bilateral, scattered areas of centrilobular groundglass, right greater than left, with small pleural effusions, right greater than left and compressive atelectasis. Mild basilar subsegmental atelectasis.A solid right lower lobe subpleural nodule measures 5 mm (series 9, image 148) which is probably benign in the patient's age range.MEDIASTINUM AND HILA: The heart is enlarged, without pericardial effusion. No visible coronary artery calcification.No significant mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.No evidence of pulmonary embolism.2.Prominent septal lines, bilateral groundglass, and pleural effusions, compatible with pulmonary edema, likely due to CHF.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Female 65 years old; Reason: r/o fracture, dislocation History: pain s/p fall RIGHT WRIST: We see no fracture or dislocation. Cyst formation along the proximal margin of the lunate could represent ulnocarpal abutment. LEFT HIP: Mild osteoarthritis affects the left hip. We see no fracture or dislocation. | Mild degenerative changes of the hip and wrist, without fracture. |
Generate impression based on findings. | No acute intracranial hemorrhage, masses, mass effect or midline shift. No CT evidence of acute large territorial ischemia. There are no extraaxial fluid collections or subdural hematomas. Moderate prominence of the ventricles and sulci, likely age-related volume loss. Moderate periventricular and subcortical white matter hypoattenuation consistent with age indeterminate small vessel ischemic disease. The visualized portions of the paranasal sinuses and mastoid air cells are clear. | No acute intracranial hemorrhage or CT evidence of large acute territorial ischemia. If there is high clinical concern for acute ischemia, further evaluation with MRI is recommended. |
Generate impression based on findings. | Dislocation status post reduction Two views of the right shoulder show reduction of the humeral head dislocation to near anatomic alignment. | Reduction of the glenohumeral dislocation. |
Generate impression based on findings. | No acute intracranial hemorrhage. The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are clear. | No acute intracranial hemorrhage. |
Generate impression based on findings. | 14 day old female with shortness of breath. Evaluate for pneumonia.VIEW: Chest and abdomen AP (two view) 2/20/2015 19:06 ET tube below the thoracic inlet and above the carina. Feeding tube tip in the stomach.Left-sided aortic arch, cardiac apex and stomach. Cardiothymic silhouette is normal. No focal pulmonary opacities. No pleural effusion or pneumothorax.Disorganized bowel gas pattern with no evidence of obstruction. No evidence of pneumatosis intestinalis, pneumoperitoneum, portal venous gas or ascites. | No evidence of pneumonia. |
Generate impression based on findings. | New hypoattenuation in the right putamen extending to the caudate with local mass effect upon the frontal horn of the right lateral ventricle without midline shift. No evidence of acute intracranial hemorrhage. The ventricles and sulci are otherwise normal in size. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are clear. | Findings compatible with acute ischemia in the right lenticulostriate arterial distribution without evidence of acute hemorrhage.Findings were discussed by the overnight resident physician, Dr. Mikin Patel, with Dr. Louissant over the phone at 1:55 AM on 2/21/2015 |
Generate impression based on findings. | Female 28 years old; Reason: evaluate dislocation History: pain, deformity Three views of the right shoulder demonstrate an anterior subcoracoid dislocation of the humeral head with respect to the glenoid. A small ossific density projects inferior to the glenoid and possibly represents an old Bankart fracture, appearing similar to that seen on the prior study. | Anterior shoulder dislocation, as above. |
Generate impression based on findings. | 15-year-old female with abdominal pain, history of Crohn's disease. Evaluate for toxic megacolon.VIEWS: Abdomen AP and left lateral decubitus (two views) 2/20/2015 Mild gaseous distention of the transverse colon with a nonobstructive bowel gas pattern. No evidence of pneumoperitoneum, pneumatosis intestinalis, portal venous gas or ascites. | Gaseous distention of transverse colon with no evidence of obstruction. No evidence of toxic megacolon as clinically questioned. |
Generate impression based on findings. | Female 24 years old; Reason: evaluate for fracture History: diffuse spine pain, s/p MVC We see no fracture or malalignment. The spine appears normal for the patient's age. | No fracture or other findings to account for the patient's pain. |
Generate impression based on findings. | No acute intracranial hemorrhage. Gray-white matter differentiation is preserved. The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are clear. | No acute intracranial hemorrhage. |
Generate impression based on findings. | Straightening of the cervical spine may be secondary to muscle spasm versus positioning. Vertebral body heights are well-maintained without evidence of fracture or traumatic subluxation. C2/3: Minimal disk bulge without significant central spinal canal stenosis.C3/4: Minimal disk bulge without significant central spinal canal stenosis.C4/5: Minimal disk bulge without significant central spinal canal stenosis.C5/6: No significant central spinal canal stenosis. C6/7: No significant central spinal canal stenosis.C7/T1: No significant central spinal canal stenosis. | No acute fracture or traumatic subluxation. |
Generate impression based on findings. | Reason: eval for PE History: multiple prior PEs, pleuritic chest pain PULMONARY ARTERIES: No evidence of pulmonary embolism. The main pulmonary artery is normal in caliber.LUNGS AND PLEURA: No suspicious pulmonary nodules or masses.Mild dependent atelectasis. No focal air space consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. No visible coronary artery calcifications.No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. Small splenules are noted. | No evidence of pulmonary embolism or other acute abnormality to account for the patient's symptoms.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Female 33 years old; Reason: Evaluate for foreign body. History: Multiple dog bites There are soft tissue defects at the dorsal aspect of the distal forearm, with foci of soft tissue gas. There is an underlying comminuted minimally-displaced fracture of the ulnar margin of the distal radial metadiaphysis. An additional round lucency in the distal radial metadiaphysis may represent a puncture defect. We see no radiopaque foreign body in the forearm. Constriction of the proximal soft tissues of the forearm is presumably due to a rolled-up sleeve. There is swelling of the thenar eminence with soft tissue gas in the web space. Dorsal soft tissue swelling is also seen. We see no fracture of the bones of the hand. We see no radiopaque foreign body in the hand. | Distal radial fracture and soft tissue defects, as above. We see no radiopaque foreign body. |
Generate impression based on findings. | Reason: High-res chest CT to evaluate for lung pathology History: SOB, RH failure LUNGS AND PLEURA: Scattered, basilar predominant ground glass and scarring (series 4, image 33), likely related to inflammatory process, including aspiration.No focal airspace consolidation.Scattered small areas of mosaic attenuation.No pleural effusion.Small nodularity along the minor fissure (series 4, image 26) is benign in morphology. Additional scattered benign appearing micronodules. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: The heart is enlarged, without pericardial effusion. No visible coronary artery calcification. Hypoattenuation of the blood pool, suggestive of anemia.The main pulmonary artery is enlarged. Prominent more distal pulmonary arteries are also noted.No mediastinal or hilar lymphadenopathy is identified within the limits of noncontrast imaging.CHEST WALL: Increased osseous density diffusely, related to renal osteodystrophy.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Moderate ascites. Distended, debris filled stomach. Diffusely increased liver density, which may relate to hemochromatosis in the proper clinical context. | 1. Enlargement of the main pulmonary artery and its branches suggests pulmonary hypertension. Scattered mosaic attenuation can be due to primary pulmonary artery hypertension.2. Scattered, dependent ground glass and scarring, likely related to inflammatory process, including aspiration. |
Generate impression based on findings. | No acute intracranial hemorrhage. No CT evidence of acute large territorial ischemia. Mild to moderate prominence of the ventricles and sulci, likely age related volume loss. There are no masses, mass effect or midline shift. There are no extraaxial fluid collections or subdural hematomas. Mild mucosal thickening of the left maxillary sinus; otherwise, the visualized portions of the paranasal sinuses and mastoid air cells are clear. | No acute intracranial hemorrhage or CT evidence of acute large territorial ischemia. If there is high clinical suspicion for acute ischemia, further evaluation with MRI is recommended. |
Generate impression based on findings. | No CT evidence of acute large territorial ischemia. No acute intracranial hemorrhage. The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are clear. | No CT evidence of acute large territorial ischemia. If there is high clinical suspicion for acute ischemia, further evaluation with MR is recommended. |
Generate impression based on findings. | No acute intracranial hemorrhage or CT evidence of acute large territorial ischemia. The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are clear. Chronic left lamina papyracea fracture. | No acute intracranial abnormality. |
Generate impression based on findings. | No diffusion-weighted abnormalities to suggest acute ischemia. Periventricular, subcortical white matter, as well as basal ganglia T2/FLAIR signal abnormality consistent with chronic small vessel ischemic disease is not significantly changed compared to previous examination. No evidence of acute intracranial hemorrhage, extraaxial fluid collections or subdural hematomas. There are no masses, mass effect or midline shift. Mild prominence of the ventricles and sulci consistent with age related volume loss. The pituitary gland is normal in size. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. | 1.No evidence of acute ischemia.2.Findings consistent with chronic small vessel ischemic disease are unchanged. |
Generate impression based on findings. | Reason: restaging glottic cancer. Follow up of lung nodule History: none CHEST:LUNGS AND PLEURA: Apical pleural scarring, compatible with radiation reaction.The right upper lobe spiculated nodule is increased in size from the prior exam, now measuring 1.9 x 1.4 cm (series 6, image 38), previously 1.7 x 1.3 cm, with continued extension toward the pleural surface. In 05/2014, this lesion measured 1.2 x 0.8 cm. This increase in size is well visualized on coronal imaging (coronal image 34).A 5 mm, poorly defined left upper lobe nodule (series 6, image 45) is new/increased from the prior exam.Additional right upper lobe pleural based nodule (series 6, image 30) appears stable.Mild basilar subsegmental atelectasis/scarring. No focal air space consolidations. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. Mild coronary artery calcification.Scattered calcified lymph nodes from prior granulomatous disease. No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: Scattered splenic granulomas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Probable renal cysts, unchanged.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches.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. | Continued increase in size of a spiculated right upper lobe nodule. Findings highly suspicious for malignancy, including primary lung neoplasm or metastatic disease. |
Generate impression based on findings. | There has been interval evolution of postoperative findings related to left frontal craniotomy for resection of a left frontal lobe tumor with decreased residual hemorrhage in resection cavity. Persistent edema in the left frontal lobe. Additionally, there is extensive vasogenic edema in the right frontal lobe. No midline shift or herniation. The ventricles are unchanged in size and configuration. No new intracranial hemorrhage. Mild right and minimal left maxillary sinus mucosal thickening; otherwise, the visualized portions of the paranasal sinuses and mastoid air cells are clear. | 1.Interval evolution of postoperative findings related to left frontal craniotomy for resection of left frontal lobe metastases with persistent surrounding vasogenic edema and decreased residual blood products.2.Unchanged right frontal lobe vasogenic edema related to metastatic disease. |
Generate impression based on findings. | Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The conus is normal in signal and morphology and terminates at an appropriate level. The visualized intra-abdominal and paraspinal contents are unremarkable.There is diffuse disc desiccation with discogenic reactive endplate changes especially notable at L5/S1. A prominent Schmorl's node is noted involving the superior endplate of L1.T12/L1: Mild disc bulge without stenosisL1/2: Mild disc bulge without stenosisL2/3: Diffuse annular disc bulge, ligamentum flavum thickening, and mild bilateral facet hypertrophy. There is mild bilateral lateral recess and mild bilateral neural foraminal stenosis.L3/4: Diffuse annular disc bulge, ligamentum flavum thickening, and mild bilateral facet hypertrophy. There is mild to moderate bilateral lateral recess and mild to moderate bilateral neural foraminal stenosis.L4/5: Diffuse annular disc bulge, ligamentum flavum thickening, and mild to moderate bilateral facet hypertrophy. There is mild central, marked bilateral lateral recess, and mild to moderate bilateral neural foraminal stenosis.L5/S1: Asymmetric bulge to the left, ligamentum flavum thickening, and mild bilateral facet hypertrophy. Bilateral S1 nerve root sheath origins are abutted and flattened. There is moderate left neural foraminal and mild right neural foraminal stenosis.SI Joints: Bilateral bridging marginal osteophytes (right greater left) of osteoarthritis. | 1.L2/3: Mild bilateral lateral recess and mild bilateral neural foraminal stenosis.2.L3/4: Mild to moderate bilateral lateral recess and mild to moderate bilateral neural foraminal stenosis.3.L4/5: Mild central, marked bilateral lateral recess, and mild to moderate bilateral neural foraminal stenosis.4.L5/S1: Bilateral S1 nerve root sheath origins are abutted and flattened. There is moderate left neural foraminal and mild right neural foraminal stenosis. |
Generate impression based on findings. | The vertebral column alignment is within normal limits. There is a normal relationship of the dens with the arch of C1. There is no acute fracture or pre-vertebral soft tissue swelling. There is no significant spinal canal stenosis. There is bulky atherosclerotic calcification of both carotid bulbs and proximal internal carotid arteries as well as calcification within the cavernous carotid arteries. There is a 7-mm hypoattenuating nodule in the right thyroid lobe. There are multiple unchanged partially imaged foci of rounded low attenuation within the cerebellum most compatible with chronic infarcts and global brain volume loss. There is a subcentimeter sclerotic lesion within the right aspect of the C2 vertebral body most compatible with an enostosis. There is fusion of the right C2-C3 facet joint. There are severe degenerative changes of both temporomandibular joints, right greater the left. | 1.No evidence of cervical spine fracture.2.Multiple chronic appearing cerebellar infarcts. |
Generate impression based on findings. | Postoperative changes of right frontal craniotomy. Right frontal pneumocephalus and small amount of hemorrhage at periphery of the resection cavity consistent with interval resection of right precentral intra-axial mass. The ventricles are unchanged in size and configuration. No evidence of a midline shift or herniation. The visualized portions of the paranasal sinuses and mastoid air cells are clear. | Postoperative changes of interval resection of right precentral intra-axial mass with small amount of hemorrhage at the resection cavity. |
Generate impression based on findings. | Reason: 55 yo F with recurrent DVT/PE and concern for unstable angina, p/w chest pain and SOB. History: see above LUNGS AND PLEURA: Scattered benign-appearing micronodules, some calcified. No suspicious pulmonary nodules or masses.Focal left upper lobe fibrosis, compatible with postradiation findings, stable. Mild basilar predominant subsegmental scarring/atelectasis. No focal air space consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without significant pericardial effusion. No visible coronary artery calcifications.No mediastinal or hilar lymphadenopathy.CHEST WALL: Status post left mastectomy, left axillary lymph node dissection.Mild degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | No acute abnormality to account for the patient's symptoms. No evidence of metastatic disease. |
Generate impression based on findings. | 17-month-old female with secretions. Evaluate for pneumonia.VIEW: Chest AP (one view) 2/20/2015 23:55 Tracheostomy tube and gastrostomy tube unchanged. Ventriculoperitoneal shunt coursing through the right neck, right hemithorax and upper abdomen. Cardiothymic silhouette is normal. Coarse bilateral interstitial opacities with right middle lobe atelectasis. No focal pulmonary opacity. No pleural effusion or pneumothorax. | Findings suggestive of BPD with right middle lobe atelectasis. |
Generate impression based on findings. | ReintubationVIEW: Chest AP ET tube tip at the level of the thoracic inlet. NG tube tip in the stomach. The umbilical venous catheter tip in the IVC. Cardiothymic silhouette normal. There is a new moderate-sized left pneumothorax with mild mediastinal shift from left to right. Diffuse atelectasis bilaterally. | Moderate size left pneumothorax new from prior study. |
Generate impression based on findings. | Evaluate pleural effusionVIEW: Chest AP 2/20/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Right central line in place. Note that the left chest tube is along the left costophrenic angle likely to be external in location. Cardiothymic silhouette normal. Diffuse atelectasis bilaterally left greater than right. There is a small left pleural effusion new from prior study. No evidence of pneumothorax. | Malpositioned left chest tube with development of small left pleural effusion. |
Generate impression based on findings. | There has been interval excision of left substernal nodule. Heterogeneous right thyroid gland measures 5.5 x 4.0 cm (series 6, image 46), previously measuring 4.9 x 3.8 cm (series 2, image 62); there is associated leftward deviation of the trachea with evidence of a tracheostomy. The tracheostomy tube tip lies just anterior to the trachea and contains soft tissue density material within the end the tracheostomy. The airway is otherwise patent.Anterior mediastinal enhancing mass measures 3.6 x 2.3 cm (series 6, image 67), previously measuring 3.3 x 1.9 cm (series 2, image 83). Additionally, there are mildly prominent mediastinal lymph nodes, which are not significantly changed compared to previous exam.The parotid and submandibular glands are normal in size and symmetric bilaterally without masses. There are no nasopharyngeal, oropharyngeal or laryngeal masses. The lung apices are clear. There is no clinically significant adenopathy. | 1. The tracheostomy tube tip lies just anterior to the trachea and contains soft tissue density material within the end the tracheostomy. Otherwise, the airway is patent. 2.Mild interval increase in size of heterogeneous right thyroid gland nodule with associated leftward deviation of the trachea.3.Mild interval increase in size of the anterior mediastinal mass.Findings relayed to Dr. Philip Knollman on 2/21/2015 over the phone at 10:45 am. |
Generate impression based on findings. | Respiratory failureVIEW: Chest AP 2/20/15 ET tube tip below thoracic inlet and above the carina. NG tube tip at the GE junction. The umbilical arterial catheter is unchanged. Cardiothymic silhouette normal. Diffuse atelectasis bilaterally in the right lower lobe and left lower lobe not significantly changed. | Diffuse atelectasis bilaterally not significantly changed. |
Generate impression based on findings. | Reason: eval PNA vs atypical PNA. Pt is s/p moxi with worsening CT findings at OSH History: cough, nonproductive LUNGS AND PLEURA: Scattered areas of consolidation, more prominent on the right, with surrounding groundglass, are new from the prior CT exam and correlate with the opacities seen on recent chest radiograph.Previously described focal ground glass opacity in the anterior right upper lobe is not seen on this exam and the setting of scattered consolidation.No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. Moderate coronary artery calcification. Significant calcification of the thoracic aorta and its branches.No mediastinal or hilar lymphadenopathy within limits of noncontrast imaging.CHEST WALL: Degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Contracted gallbladder, with multiple gallstones, similar in appearance to the prior exam. | Scattered areas of consolidation and surrounding groundglass are new from the prior CT exam and correlate with the opacities seen on recent chest radiograph. Findings compatible with pneumonia or aspiration. |
Generate impression based on findings. | 13-month-old male with crying. Evaluate for shunt malfunction.VIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views), abdomen AP/lateral (two views) 2/21/2015 Ventriculoperitoneal shunt tip in the midline of the calvarium and exiting via right parietal-occipital burr hole. Tubing is seen coursing along the soft tissues of the right neck, the anterior right hemithorax, and throughout the abdomen with tip terminating in the right hemipelvis. Portions of the shunt tubing are radiolucent especially along the soft tissues of the right neck limiting optimal evaluation. No evidence of kinking or other abnormality to suggest malfunction. Calvarium appears normal. Cardiothymic silhouette is normal. No focal pulmonary opacities. No pleural effusion or pneumothorax. Disorganized nonobstructive bowel gas pattern. | Portions of tubing are radiolucent limiting optimal evaluation however there is no evidence of shunt malfunction. |
Generate impression based on findings. | Respiratory failureVIEW: Chest AP 2/21/15 Left upper extremity PICC with tip in the SVC. Cardiothymic silhouette normal. Hyperinflated left lung with patchy atelectasis in the right lower lobe. No pleural effusion or pneumothorax. | Hyperinflated left lung with patchy atelectasis in the right lower lobe. |
Generate impression based on findings. | Increased vent settingsVIEW: Chest AP 2/21/15 ET tube tip below thoracic inlet and above the carina. NG tube tip at the GE junction. Left PICC and umbilical catheters unchanged. There is an abdominal drain at the left upper quadrant unchanged. Cardiothymic silhouette normal. Diffuse atelectasis bilaterally not significantly changed. No pleural effusion or pneumothorax. | Diffuse atelectasis bilaterally not significantly changed. |
Generate impression based on findings. | Reason: Evaluate for pulmonary infectious process, granulomatous disease, fungal infection History: Patient has history of lung biopsy with necrotizing and non-necrotizing granulomas, and suspected of having systemic fungal infection LUNGS AND PLEURA: Suture material seen in the right lung from prior wedge resections.No suspicious pulmonary nodules or masses.No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. No visible coronary artery calcification. Hypoattenuation of the blood pool, suggestive of anemia. Right arm PICC, tip near the cavoatrial junction.No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Surgical changes of prior wedge resections, without acute abnormality. Specifically, no evidence of infection. |
Generate impression based on findings. | Evaluate chest tubeVIEW: Chest AP 2/20/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Right central line in place. Placement of a left chest tube projected over the left mid lung. Cardiothymic silhouette normal. There is improved aeration within the left lung. There is a small left subpulmonic pneumothorax. Bilateral atelectasis but improved in the left lung. | Placement of a left chest tube with improved aeration in the left lung. |
Generate impression based on findings. | Postoperative changes of anterior cervical fusion from C4 through C7. There is backing out of the right-sided screw at C7 by approximately 6 mm into the overlying soft tissues. Cortical screws are present at C4, C6, and C7 with evidence of diskectomy and corpectomy at C4/5 through C5/6 with bone grafting. Additionally, there has been diskectomy at C6/7. No evidence of acute fracture or traumatic subluxation.C2/3: Mild left facet arthropathy results in mild left neural foraminal narrowing. No significant central spinal canal stenosis.C3/4: No significant central spinal canal stenosis or neural foraminal narrowing.C4/5: Endplate spurring resulting in mild right neural frontal stenosis. No significant central spinal canal stenosis.C5/6: No significant central spinal canal stenosis or neural foraminal narrowing.C6/7: No significant central spinal canal stenosis or neural foraminal narrowing.C7/T1: No significant central spinal canal stenosis or neural foraminal narrowing. | 1.Postoperative changes of anterior cervical fusion from C4 through C7 with backing out of the right sided C7 screw by 6 mm into the overlying soft tissues. 2.No acute fracture or traumatic subluxation. |
Generate impression based on findings. | Evaluate ET tubeVIEW: Chest AP 2/21/15 ET tube tip immediately above the carina. NG tube tip at the GE junction. The umbilical venous catheter tip in the IVC. Left chest tube unchanged. Cardiothymic silhouette normal. Diffuse atelectasis bilaterally unchanged. No pleural effusion or pneumothorax. | ET tube tip immediately above the carina. |
Generate impression based on findings. | 5-day-old female with desaturation, jerking, apnea.VIEW: Chest and abdomen AP (two view) 2/21/2015 09:15 Left sided aortic arch, cardiac apex and stomach.Cardiothymic silhouette is normal. No focal pulmonary opacity. No pleural effusion or pneumothorax.Nonobstructive bowel gas pattern. Distended bladder. | Normal examination. |
Generate impression based on findings. | DesaturationVIEW: Chest AP 2/20/15 ET tube tip immediately above the carina. NG tube tip at the GE junction. The umbilical venous catheter tip in the IVC. Placement of the left chest tube with interval resolution of the left pneumothorax. Cardiothymic silhouette normal. Diffuse atelectasis bilaterally unchanged. There is a small amount of fluid in the minor fissure. | Placement of a left chest tube with interval resolution of the left pneumothorax. |
Generate impression based on findings. | Reason: h/o HNC, s/p induction, for CRT History: none CHEST:LUNGS AND PLEURA: Scattered benign-appearing micronodules are stable. No suspicious pulmonary nodules or masses.No focal air space consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, with a pericardial effusion. No visible coronary artery calcification.Scattered small mediastinal and hilar lymph nodes are unchanged.CHEST WALL: Degenerative disease of the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Scattered renal hypodensities appear similar to the prior exam, likely cysts.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. | No evidence of metastatic disease. |
Generate impression based on findings. | 12 year old male with hypoxia. Evaluate ET tube placement.VIEW: Chest AP (one view) 2/21/2015 9:14 ET tube tip below thoracic inlet and above the carina. Cholecystectomy clips in the right upper quadrant. Cardiothymic silhouette is normal. Interval increase in patchy opacities in the left upper lobe and left lower lobe. No pleural effusion or pneumothorax. Marked dextrorotary scoliosis is again seen. | 1. ET tube tip below thoracic inlet and above the carina. 2. Interval increase in patchy opacities in the left lung. |
Generate impression based on findings. | Respiratory failureVIEW: Chest AP and abdomen AP ET tube tip below thoracic inlet and above the carina. NG tube tip at the lower esophagus. The umbilical venous catheter tip in the umbilical vein. The umbilical arterial catheter tip is unchanged. Cardiothymic silhouette normal. Patchy atelectasis bilaterally not significantly changed. Absent bowel gas without pneumoperitoneum. | Patchy atelectasis bilaterally not significantly changed. |
Generate impression based on findings. | There is a small focus of T2 hyperintensity involving the medial right frontal lobe (best seen FLAIR imaging series 6 image 4-5/26) which involves cortical gray matter. It does not have significant mass effect, with no signal abnormality on other sequences. It measures up to 12 mm in maximal size.The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There is no 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. Mucosal thickening is present within left ethmoid air cells as well as scattered foci in sporadic locations within other paranasal sinuses. There are no air-fluid levels. The mastoid air cells are clear. | 1.There is a small focus of T2 hyperintensity involving the medial right frontal lobe (best seen FLAIR imaging series 6 image 4-5/26) which involves cortical gray matter. It does not have significant mass effect, with no signal abnormality on other sequences. This appearance is nonspecific and given its small size and location may represent an inflammatory process, gliosis from past pathology (traumatic, infectious, or inflammatory) or even neoplasia. Recommendations are made to obtain MRI brain at 3 Tesla with gadolinium for further characterization.2.Results were discussed with Dr. Tao on 2/21/2015 at 9:40 a.m. |
Generate impression based on findings. | 22 month old term male with croup and complex febrile seizure. There is no evidence of intracranial hemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | No acute intracranial findings by noncontrast CT head. |
Generate impression based on findings. | Female 29 years old; Reason: epigastric pain ABDOMEN:LUNGS BASES: Incompletely imaged central venous catheter with tip near cavoatrial junction. Small right pleural effusion and atelectasis.LIVER, BILIARY TRACT: Mild intrahepatic biliary duct prominence, probably unchanged from earlier MRI exam. No extrahepatic biliary duct dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Regions of pancreatic head and neck not well seen with soft tissue heterogeneity seen in region, uncertain whether due in part to parenchymal atrophy. Correlation with patient's clinical history recommended.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Upper abdominal postsurgical sequela. Normal sized appendix. Underdistended bowel in right lower quadrant and in deep right hemipelvis, making assessment suboptimal. Moderate to large stool in colon. PELVIS:UTERUS, ADNEXA: Tampon suggested.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Scoliosis. | 1. Small right pleural effusion.2. Moderate to large stool, correlate clinically for constipation.3. Regions of pancreatic head and neck not well seen with soft tissue heterogeneity seen in region, uncertain whether due in part to parenchymal atrophy. Correlation with patient's clinical history recommended.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Point tenderness fifth metatarsal. Status post fall. Evaluate for fracture. There is soft tissue swelling, but I see no fracture. Arterial calcifications are noted in the soft tissues. | Soft tissue swelling without fracture evident. Please note that the fifth metatarsal is not visualized in its entirety on ankle radiographs, and if further imaging evaluation is clinically warranted, foot radiographs are recommended. |
Generate impression based on findings. | Dog bite Again seen are soft tissue defects at the dorsal aspect of the distal forearm, with foci of soft tissue gas. There is an underlying comminuted minimally-displaced fracture of the ulnar margin of the distal radial metadiaphysis. An additional round lucency in the distal radial metadiaphysis may represent a puncture defect. Swelling of the thenar eminence with soft tissue gas in the web space is also again seen, though better visualized on the prior hand radiographs. Dorsal soft tissue swelling and foci of gas are better seen on the current examination. We see no radiopaque foreign body. | Distal radial fracture and soft tissue defects, as described above. We see no radiopaque foreign body. |
Generate impression based on findings. | Female 63 years old; Reason: asses for metastatic disease, H/O metastatic uterine leiomyosarcoma, thyroid cancer and breast cancer CHEST:LUNGS AND PLEURA: Severe emphysema. Postsurgical changes related to right lower lobe. Unchanged 3 mm right sided lung nodule, nonspecific, image 48 series 4. MEDIASTINUM AND HILA: Status post thyroidectomy. Atherosclerotic thoracic aorta, stable dilatation measuring 3.5 cm.CHEST WALL: Left breast and axillary postsurgical sequela. Interval decrease in size of fluid collection at level of left breast postprocedural site, measuring 1.8 x 1.2 cm, image 55 series 3, previously measured 6.3 x 2.3 cm, likely reflecting a seroma, no internal gaseous foci or significant rim enhancement seen. Left lateral thoracic/subscapular lipoma.ABDOMEN:LIVER, BILIARY TRACT: Liver lesions stable in appearance. Multiple hemangiomas and cystic foci seen, additional hypoattenuating foci that are too small to characterize visualized.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: Aortobiiliac atherosclerotic disease. Reference left para-aortic lymph node unchanged, measuring 1 x 0.9 cm, image 95 series 3, previously measured 1 x 0.9 cm.BOWEL, MESENTERY: Small bowel postsurgical sequela seen.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES: Visualized osseous structures stable in appearance. | 1. Stable exam. As previously suggested, given patient's multiple malignancies, followup with PET/CT imaging may be considered.2. Left breast postoperative seroma demonstrates interval decrease in size.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Left hand swelling, pain. Evaluate progression of osteomyelitis. There is diffuse soft tissue swelling that has progressed when compared with the prior study. There has been progression of osteolysis of the volar aspect and base of the distal phalanx of the middle finger indicating progression of osteomyelitis. There is volar dislocation of the distal phalanx of the middle finger with respect to the middle phalanx. There is loss of soft tissue dorsal to the middle phalanx of the middle finger with progression of osteolysis of the head and neck of the phalanx indicating progression of osteomyelitis. Periosteal reaction along the remainder of the middle phalanx likely reflects infection of the entire bone, and there appears to be a nondisplaced pathologic fracture through the dorsal aspect of the base of the middle phalanx. There is also periosteal reaction along the diaphysis of the proximal phalanx of the middle finger, also compatible with osteomyelitis; I suspect that there is erosion along the ulnar aspect of the base of the proximal phalanx. Foci of gas density are seen within the soft tissues volar to the head and neck of the second metacarpal. There are soft tissue defects dorsal and distal to the distal third phalanx of the thumb with questionable erosion of the tuft of the distal phalanx. Evaluation of the index, ring, and fifth fingers is limited due to inability to optimally position the patient. There is chondrocalcinosis of the wrist. | Progression of osteomyelitis and soft tissue infection as described above. |
Generate impression based on findings. | 75 year old female with vegetations on ICD lead and concern for septic emboli. There is no evidence of intracranial hemorrhage. There is volume loss that is most prominent in the perisylvian regions. There are multiple patchy foci of low attenuation within the supratentorial white matter and basal ganglia most compatible with age indeterminate small vessel ischemic disease and lacunar infarcts. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is mild paranasal sinus mucosal thickening and fluid within the right mastoid air cells. | 1.No evidence of intracranial hemorrhage. 2.Multiple foci of age indeterminate small vessel ischemic disease and lacunar infarction. If there remains clinical concern for acute infarct, contrast enhanced MRI of the brain is recommended. |
Generate impression based on findings. | There has been interval reduction in the size of the nasopharyngeal mass (series 8045, image 50) with residual nasopharyngeal fullness however without a discrete measurable focus of enhancement that was demonstrated on the previous examination (series 6, image 66 on the CT neck 11/4/2014).A few scattered subcentimeter bilateral cervical lymph nodes. Index left level IIb lymph node measures 1.1 x 0.7 cm (series 8, image 28), previously measuring 1.2 x 0.7 cm.The parotid and submandibular glands are normal in size and symmetric bilaterally without masses. There are no thyroid masses. There are no oropharyngeal or laryngeal masses identified and there is no airway compromise. The lung apices are clear. Mild left and moderate right maxillary sinus mucosal thickening. | 1.Significant interval reduction in size of the nasopharyngeal mass without measurable enhancing focus. 2.Index cervical lymph node measurement as above. |
Generate impression based on findings. | Six year old female with O2 dependence. Evaluate for aspiration pneumonia.VIEWS: Chest AP/lateral (two views) 2/21/2015 Cardiothymic silhouette is normal. Right perihilar opacity likely infectious etiology. Subsegmental atelectasis in the left lower lobe. No pleural effusion or pneumothorax. | Likely right perihilar pneumonia. |
Generate impression based on findings. | 6-year-old male with history of imperforate anus with increase in fecal soiling. Evaluate degree of stool burden.VIEW: Abdomen AP (one view) 2/21/2015 10:17 Nonobstructive bowel gas pattern with moderate stool burden in the transverse and descending colon. | Moderate stool burden. |
Generate impression based on findings. | Pain and swelling in multiple joints. Evaluate for arthritis. Three views of the left hand are provided. Other than tiny osteophytes at the DIP joint of the ring finger and the basilar joint, the hand appears normal. I see no erosions or other specific radiographic features of inflammatory arthritis.Three views of the right hand are provided. Minimal degenerative arthritic changes affect the DIP joints, essentially within normal limits for age. A small round lucency with sclerotic margins in the third metacarpal head likely represents a small cyst. I see no definite erosions or other specific radiographic features of inflammatory arthritis.Four views of the right knee are provided. The knee appears normal, with no frank arthritic changes or joint effusion.Four views of the left knee are provided. Small tibial spine osteophytes suggest minimal osteoarthritis, essentially within normal limits for age. I see no joint effusion or erosions. | Minimal degenerative arthritic changes as described above, essentially within normal limits considering the patient's age. |
Generate impression based on findings. | There is a destructive, expansile, lytic lesion centered within the C2 vertebral body and involving the odontoid process. There is circumferential cortical disruption and extension into the left pedicle. Soft tissue involvement is better assessed on the recent MRI. The vertebral column alignment is within normal limits. There is no significant spinal canal stenosis. The visualized intracranial structures and lung apices appear normal. There is mild atherosclerotic calcification of the left carotid bulb. There is mild paranasal sinus mucosal thickening. | Destructive lytic lesion centered within the C2 vertebral body and involving the odontoid process with cortical disruption is potentially unstable. Soft tissue involvement is better assessed on the recent MRI. |
Generate impression based on findings. | Posterior stabilization rods with transpedicular screws entering the vertebral bodies of L5 and S1 and intravertebral disk spacer at L5/S1. The alignment otherwise, is not significantly changed. No evidence of acute fracture or subluxation.T12/L1: No significant central spinal canal stenosis.L1/2: No significant central spinal canal stenosis.L2/3: No significant central spinal canal stenosis.L3/4: No significant central spinal canal stenosis. No significant change in the mild left neural foraminal stenosis from mild lateral disk bulge.L4/5: Limited evaluation given streak artifact. Mild diffuse disk bulge with associated mild right neural foraminal narrowing, unchanged. No significant interval change in the facet arthropathy and ligamentum flavum hypertrophy resulting in mild central spinal canal stenosis.L5/S1: Limited evaluation given streak artifact. Mild diffuse disk bulge with associated mild to moderate narrowing of the neural foramina and likely lateral recess impingement, particularly on the left with suggestion of disk spacer projecting into the left lateral recess. No evidence of central spinal stenosis. | 1. Post surgical findings from L5-S1 fusion, with no evidence of acute abnormality.2. Mild to moderate degenerative disk disease in the lower lumbar spine, not significantly changed. |
Generate impression based on findings. | Pain at fifth metatarsal. Evaluate for fracture. I see no fracture. Specifically, the fifth metatarsal appears normal. There is soft tissue swelling about the ankle. The Achilles' tendon silhouette appears slightly thickened, but I cannot determine if this is due to true tendinopathy or simply adjacent soft tissue swelling. Arterial calcifications are noted within the foot and ankle. | No fracture evident. Other findings as above. |
Generate impression based on findings. | Again noted is a cluster of coarse and curvilinear calcifications measuring up to 15 mm in the left inferior parietal lobule, representing the nidus of an arteriovenous malformation. This arteriovenous malformation is supplied by an enlarged left middle cerebral artery branch and drained by cortical veins. There is an outpouching near the origin of the feeding left MCA branch that measures up to 5 mm with wide neck in the sylvian fissure. There is no evidence of significant steno-occlusive disease of the major cerebral vessels. There is no associated acute intracranial hemorrhage or vasogenic edema. Nonspecific diffuse cerebral white matter hypoattenuation, which could be related to small vessel ischemic disease of indeterminate age. There is mild prominence of the ventricles and sulci, which may be secondary to age related cerebral volume loss. No evidence of midline shift or herniation. | Left inferior parietal lobule arteriovenous malformation with a nidus that measures approximately 15 mm, supplied by a left MCA branch with associated high-flow aneurysm that measures approximately 5 mm, and drained by cortical veins. These findings appear stable. No acute intracranial hemorrhage or edema is identified. |
Generate impression based on findings. | No CT evidence of acute large territorial ischemia or acute intracranial hemorrhage. The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are clear. | No acute intracranial hemorrhage or CT evidence of acute large territorial ischemia. |
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