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Generate impression based on findings. | Evaluate for interval change in ileus, abdominal pain and constipation Enteric tube with sideport seen in gastric fundus and tip in gastric body. Moderate to large stool in colon, no evidence of bowel obstruction. Bilateral tubal ligation clips seen. | When compared to 2/18/2015 abdominal radiography, improvement in degree of bowel dilatation. Moderate to large stool in colon, correlate clinically for constipation. |
Generate impression based on findings. | Abdominal distention, monitoring of ileus Enteric tube seen with side-port beyond gastroesophageal junction, tip located in gastric body. Moderate to large stool seen in colon. Interval increase in amount of air in colon. No evidence of bowel obstruction. Bilateral tubal ligation clips present. | Enteric tube and bowel gas pattern as above. |
Generate impression based on findings. | GJ tube placement, intermittent tube feed intolerance, evaluate stool burden Percutaneous gastrojejunostomy tube with tip located beyond ligament of Treitz in left lateral mid abdomen. Nonobstructive bowel gas pattern. Below average stool burden. Interval evacuation of previously seen residual enteric contrast. Punctate radiodensity in right mid abdomen may be within bowel. Diffusely decreased osseous mineralization and degenerative disease of lumbosacral spine. Central venous catheter with tip in right atrium. | Enteric tube as above.Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Evaluate sitz markers, obstipation Mild interval progression in transit of sitz markers with a greater number now seen to the level of the splenic flexure. The markers are seen extending from the distal ascending colon to the proximal descending colon with the highest number seen in the splenic and the hepatic flexures and a few in the intervening transverse colon. Nonobstructive bowel gas patterns. | Sitz markers as described. Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Nasogastric tube placement at outside hospital Enteric tube seen with side-port just beyond gastroesophageal junction. Portion of catheter seen in right thoracic paravertebral area, nonspecific and may be related to a central line, correlation with patient's history recommended. Moderate to large residual contrast seen in incompletely imaged ascending and descending colon, smaller amount seen in portions of small bowel. | Enteric tube as above. |
Generate impression based on findings. | Dobbhoff tube placement Dobbhoff tube seen with tip in gastric body, tubing mildly kinked at level of guidewire. Incompletely imaged presumed bilateral percutaneous nephrostomy tubes. Left-sided skin staples. Relative lucency seen in right lateral abdomen, pneumoperitoneum a consideration versus artifact or lipomatous soft tissue hypertrophy. If there is clinical concern, further evaluation with upright or decubitus imaging recommended. Left basilar/retrocardiac air space disease. | 1. Enteric tube as above. Relative lucency seen in right lateral abdomen, pneumoperitoneum a consideration. If there is clinical concern, further evaluation with CT imaging or upright or decubitus radiographic imaging recommended. |
Generate impression based on findings. | Enteric tube placement Enteric tube seen with side-port in gastric body. Moderate to large stool partially seen, nonobstructive bowel gas pattern.Incompletely imaged pulmonary edema and patchy air space disease, blunting of costophrenic angle suggestive of small pleural effusions. | Enteric tube as above. |
Generate impression based on findings. | Enteric tube placement Enteric tube seen with side-port just beyond gastroesophageal junction and further advancing by approximately 9 cm recommended. Small amorphous lucency seen lateral to right hemithorax, nonspecific but may reflect subcutaneous emphysema, please refer to concomitant chest radiography from same day for additional findings. | Further advancing of enteric tubes recommended.Please refer to concomitant chest radiography from same day for additional findings. |
Generate impression based on findings. | Abdominal pain Mildly dilated small bowel measuring up to 3.5 cm. Small air seen distally in colon. While findings may reflect an ileus type bowel gas pattern, appearance is worrisome for a partial or developing small bowel obstruction. Right upper quadrant surgical clips related to prior cholecystectomy. IVC filter. Catheter overlying left lower quadrant/pelvis. Additional vascular line seen extending to L2/3 level. Pelvic surgical clip. Decreased osseous mineralization. Superiorly subluxed left femur, stable in appearance to prior study. Multiple right hilar surgical clips. Incompletely seen patchy air space disease, particularly in right mid to upper lung field. Mild cardiomegaly. | 1. Mildly dilated small bowel measuring up to 3.5 cm with small air seen distally in colon. While findings may reflect an ileus type bowel gas pattern, appearance worrisome for a partial or developing small bowel obstruction. Correlation with patient's clinical history and continued followup recommended. |
Generate impression based on findings. | Female 64 years old; Reason: history of clear cell vaginal cancer s/p total pelvic exenteration 9/2014 History: asymptomatic CHEST:LUNGS AND PLEURA: Interval resolution of previously seen pleural effusions. Biapical pleural nodularity/scarring. Elongated perifissural 8 mm focus, image 31 series 5, most likely a lymph node but continued followup recommended, additional linearity seen along left major fissure as well, image 25 series 5.MEDIASTINUM AND HILA: Mild calcified coronary artery disease. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Interval marked improvement in previously visualized pneumobilia. Common bile duct measures up to 7 mm but tapers distally, no radiopaque choledocholithiasis. SPLEEN: Small splenule. PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Heterogeneous striated nephrograms, new. Differential considerations include multifocal pyelonephritis or areas of vascular compromise/infarct or an underlying neoplastic process. No perinephric stranding. No hydronephrosis. Visualized renal veins and arteries appear patent. Interval enlargement of mildly prominent retroperitoneal lymph nodes. For example, reference 0.9 x 0.8 cm left-sided para-aortic lymph node, image 120 series 3, previously measured 0.4 x 0.4 cm.RETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: Somewhat tethered appearance of small bowel in ventral abdomen and pelvis, likely postsurgical sequela/related to nonobstructive adhesive disease. Underdistended stomach, making assessment suboptimal but appearance improved from prior study.PELVIS:UTERUS, ADNEXA: Status post pelvic exoneration/hysterectomy. Improved pelvic ascites. Small presacral soft tissue attenuation and somewhat tethered appearance of small bowel in ventral abdomen and pelvis, likely postsurgical sequela/related to nonobstructive adhesive disease.BLADDER: Status post cystectomy. Visualized right sided neobladder unremarkable.BONES, SOFT TISSUES: Left-sided ostomy and right-sided urostomy. Possible small right-sided parastomal hernia. Spinal degenerative disease. | 1. New heterogeneous striated nephrograms. Differential considerations bilateral pyelonephritis, neoplastic process/metastatic disease or areas of vascular compromise/infarct (unusual however in latter case due to bilaterality of findings, visualized vessels also appear patent). Correlation with patient's clinical history and urinalysis recommended.2. Mild interval increase is mildly prominent retroperitoneal lymph nodes (measuring up to 9 mm). |
Generate impression based on findings. | Male 62 years old; Reason: HCC, TheraSphere Procedure History: HCC CHEST:LUNGS AND PLEURA: No suspicious lung nodule.MEDIASTINUM AND HILA: Heart borderline in size. CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Ill-defined infiltrative mass in hepatic segment 8 measures 6.6 x 5.6 cm, image 21 series 9, previously measured 7.4 x 6.3 cm. Again seen are tubular hypoattenuating structures within the lesion, representing thrombosed anterior branches of right portal vein. Main portal vein and posterior branches of right portal vein patent. Smaller subcentimeter hypoattenuating focus seen anteroinferiorly, image 91 series 10, stable, may be portion of thrombosed portal vein branch but too small to characterize. Hepatic steatosis.SPLEEN: Spleen stable in size.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric renal parenchymal enhancement.RETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: Tiny hiatal hernia.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Visualized osseous structures stable in appearance. Multilevel degenerative changes of spine. Ventral abdominal subcutaneous nodularity, may reflect sequela of prior injection sites. | Mild interval decrease in size of hepatic segment 8 mass as described. |
Generate impression based on findings. | Female 64 years old; Reason: 64 y/o appendiceal ca, on a chemo holiday, please compare to prior CT in 11/2014 CHEST:LUNGS AND PLEURA: Slight interval increase in size of reference left lower lobe lung nodule, measuring 1 x 0.8 cm, image 46 series 4, previously measured 1 x 0.6 cm. No pleural effusion.MEDIASTINUM AND HILA: Incompletely imaged mildly heterogeneous thyroid gland. Moderate cardiomegaly.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No apparent change in extensive multifocal hepatic contour scalloping secondary to extensive peritoneal metastatic disease. Stable to slight interval increase in size of hepatic segment 5 reference lesion, measuring 1.4 x 1.1 cm on image 73 series 3, previously measured 1.3 x 1 cm.SPLEEN: Unchanged extensive contour scalloping as a result of extensive peritoneal metastatic disease.PANCREAS: Stable appearance with contour deformity due to peritoneal disease again seen.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys stable in appearance, bilateral renal cysts.BOWEL, MESENTERY: Overall peritoneal/omental metastatic tumor burden and ascites without apparent change.PELVIS:UTERUS, ADNEXA: Uterus absent or atrophic.BLADDER: Collapsed, making assessment suboptimal.BONES, SOFT TISSUES: Disease containing right inguinal hernia/mass slightly increased in size, measuring 3.2 x 2.4 cm, image 177 series 3, previously measured 2.8 x 2.2 cm. Bowel no longer seen in left sided ventral abdominal hernia. Additional smaller sites of ventral abdominal herniation again seen. | 1. Stable to slight interval increase in size of reference measurements as above. Overall extensive peritoneal/omental tumor burden without apparent change. |
Generate impression based on findings. | Female 55 years old; Reason: questionable history of IVC filter ABDOMEN:LUNGS BASES: Right-sided chest tube seen with interval decrease in size of previously visualized moderate right pleural effusion. Increasing small left pleural effusion present. Innumerable pulmonary and pleural metastatic lesions. Comparison difficult due to differences in technique and evaluation on this nondedicated exam but lung metastatic lesions appear to have increased in number when compared to prior study.LIVER, BILIARY TRACT: Enlarging hepatic metastases. Reference lesion seen in hepatic segment 8 measures 3.5 x 3.1 cm, previously measured 2.5 x 2.4 cm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Multiple hypodensities seen in both kidneys, suspicious for metastases and without significant change. Reference focus in right anterior kidney measures 2.3 x 1.4 cm on image 34 series 4, previously measured 2.3 x 1.5 cm. Nonobstructing intrarenal nephrolithiasis.RETROPERITONEUM, LYMPH NODES: Gastrohepatic lymphadenopathy, increased in size, measuring up to 1.7 cm in maximum short axis dimension, previously measured up to 0.9 cm. Portacaval adenopathy. IVC filter present with small amount of clot at inferior aspect of filter, image 59 series 4.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Calcified leiomyomatous disease.BLADDER: Collapsed, making assessment suboptimal.BONES, SOFT TISSUES: Subtle lucency in left iliac wing remains suspicious for metastatic disease. Trace ascites. | 1. Innumerable pulmonary and pleural metastatic lesions. Comparison not optimal but lung metastatic lesions appear to have increased in number when compared to prior study.2. Enlarging hepatic metastases. 3. Gastrohepatic lymphadenopathy, increased in size.4. IVC filter present with small amount of clot. 5. Renal metastatic disease without significant change. 6. Decreased size of right pleural effusion with chest tube in place. Increasing small left pleural effusion. 7. Trace ascites. |
Generate impression based on findings. | T4N3M1 HPV+ squamous cell carcinoma of the right tonsil status post treatment. There are post-treatment findings in the neck with diffuse marked supraglottic edema with airway narrowing and superficial areas of hyperenhancement in the right oropharynx. Otherwise, there is no discretely measurable upper aerodigestive track mass. In addition, there is decrease in size of the right supraclavicular lymphadenopathy, which measures 19 x 22 mm, previously 33 x 47 mm. The salivary glands and thyroid appear unchanged. The airway inferior to the tracheostomy tube is patent. There is a left internal jugular venous catheter. The major vessels in the neck appear to be patent, although a portion of the right internal jugular vein remains somewhat narrowed. There is partial opacification of the maxillary sinuses and mastoid air cells bilaterally. The imaged intracranial structures are unremarkable. There is multilevel degenerative spondylosis of the cervical spine. There is unchanged lucency in the right glenoid, which is likely degenerative in nature. | 1. Post-treatment findings in the neck with diffuse marked supraglottic edema with airway narrowing and superficial areas of hyperenhancement in the right oropharynx, which may represent mucositis and/or treated tumor. 2. Continued interval decrease in size of the lymphadenopathy. |
Generate impression based on findings. | Reason: r/o bleed History: assault CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.CT maxillofacial bones:There is a comminuted fracture along the anterior and posterior aspect of the maxillary alveolar ridge involving the roots of teeth #21-26 (mandibular incisors and left mandibular canine and left mandibular premolar) associated with anterior tooth displacement. The left mandibular canine is essentially free floating anterior to the mandible. The crown of the left premolar is absent.There are impacted maxillary molars present with periapical lucency along the left impacted molar. Some roots of mollars extend into the maxillary sinuses.The skull base foramina are intact.The orbits are intact with no abnormal mass lesions in either orbit. The visualized eyeballs are intact lacrimal glands are unremarkable. Extraocular muscles are intact. The suprasellar cistern is unremarkable.Visualized portions of the mastoid air cells and middle ears are clear. The visualized portions of the paranasal sinuses demonstrate mucosal thickening. CT cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. No fractures are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.There is a comminuted fracture along the anterior and posterior aspect of the maxillary alveolar ridge involving the roots of teeth #21-26 (mandibular incisors and left mandibular canine and left mandibular premolar) associated with anterior tooth displacement. The left mandibular canine is essentially free floating anterior to the mandible. The crown of the left premolar is absent. Please correlate with clinical findings.3.No cervical spine fracture is identified. |
Generate impression based on findings. | Female 43 years old; Reason: PID History: cervical motion tenderness ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mildly prominent retroperitoneal/left para-aortic lymphadenopathy, measuring up to 8 mm in maximum short axis dimension.BOWEL, MESENTERY: No secondary signs of appendicitis. PELVIS:UTERUS, ADNEXA: Lobular hypoattenuating structure measuring 2.3 x 1.7 cm seen in expected area of endometrial complex, image 103 series 3. Relatively hyperattenuating rim or surrounding hyperattenuation, nonspecific but rim enhancement not entirely excluded.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted. | 1. Lobular/bilobed hypoattenuating structure measuring 2.3 x 1.7 cm seen in expected area of endometrial complex. Patient's pregnancy test reportedly negative and patient stated her 'uterine lining' was removed 20 years ago, also status post tubal ligation. Given patient's clinical symptoms of cervical motion tenderness, infectious process/abscess formation a consideration. Fibroid formation or cystic endometrial benign or malignant also differential considerations, further characterization with pelvic sonography recommended. |
Generate impression based on findings. | Female 45 years old; Reason: necrotizing pancreatitis complications History: Abdominal pain, weight loss ABDOMEN:LUNGS BASES: Large right pleural effusion with underlying compressive atelectasis and mediastinal shift towards left. Left basilar linear atelectasis/scarring.LIVER, BILIARY TRACT: Focal fatty infiltration along ligamentum teres. SPLEEN: No significant abnormality noted.PANCREAS: Multiple peripancreatic fluid collections, seen extending from pancreatic body area and upward into lower mediastinum as well. One collection measuring 7.1 x 3.2 cm contains ovoid soft tissue attenuation measuring 3.9 x 1.9 cm, image 45 series 4, may represent adherent debris or age indeterminate blood clot. Tiny caliber vessels are seen adjacent to this structure. This is a nondedicated exam and thus evaluation is suboptimal but no definite active contract contrast extravasation seen. Additional rim enhancing fluid collection seen in left posterior perinephric/posterior pararenal region, measuring up to 4 x 2.6 cm on transaxial imaging, image 68 series 4, left kidney displaced anteriorly as a result. Celiac axis and superior mesenteric artery patent, visualized common hepatic and splenic arteries appear patent. Patent portal veins, SMV and splenic vein.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric renal parenchymal enhancement.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Moderate pelvic ascites. Asymmetric prominence of left iliopsoas muscle, may be reactive in etiology. | 1. Peripancreatic and additional lower mediastinal and retroperitoneal fluid collections, given patient's diagnosis of ongoing pancreatitis, suspicious for pseudocyst formation. One such collection contains higher density, nonspecific and may represent adherent debris or age indeterminate blood clot. Correlation with patient's clinical status and laboratory values/hemoglobin levels recommended. If there is concern for active hemorrhage, CT or conventional angiographic imaging recommended. Asymmetric prominence/edema involving left iliopsoas muscle. 2. Large right pleural effusion with underlying compressive atelectasis and mediastinal shift towards left. |
Generate impression based on findings. | Male 58 years old; Reason: pancreatitis, drainage of over 2L of purulent fluid by interventional GI this PM with subsequent Hgb drop, assess for bleeding/hematoma History: abdominal pain Suboptimal study due to beam hardening artifact from patient's arms, making assessment for layering dependent hyperdensity particularly difficult. ABDOMEN:LUNGS BASES: Increasing moderate to large bilateral pleural effusions. Mild calcified coronary artery disease. Mild cardiomegaly.LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: Interval cyst gastrostomy placement. Collection at and inferior to pancreas/along greater curvature of stomach demonstrates interval decrease in size and enteric contrast seen collecting in the fluid collection, presumably due to the presence of the cyst gastrostomy. Foci of gas also present in collection, likely iatrogenic. Component of collection measures 5.4 x 2.8 cm, image 64 series 3, previously measured 11.4 x 10.8 cm. Decrease in size of previously seen large fluid collection that displaced spleen medially also visualized. On current study, portion of this collection measures 11 x 1.8 cm, image 46 series 3, previously measured 14.2 x 5.1 cm. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerotic disease. BOWEL, MESENTERY: Enteric tube seen extending into gastric body. Again seen is diffuse small and large bowel wall thickening with particularly marked thickening involving proximal jejunum.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES, OTHER: Multilevel degenerative changes of spine. Small to moderate mildly complex abdominopelvic ascites. Diffuse anasarca and scrotal edema. | 1. Suboptimal assessment for hyperdense fluid as above. Amount of abdominopelvic ascites similar to prior study. Interval decrease in size of left upper abdominal fluid collections. 2. Again seen is diffuse small and large bowel wall thickening with particularly marked thickening involving proximal jejunum, bowel ischemia again not entirely excluded.3. Increasing bilateral pleural effusions. 4. Diffuse anasarca, marked scrotal edema. |
Generate impression based on findings. | Female 82 years old; Reason: diverticulitis, colitis History: nausea, vomiting, diarrhea, abdominal pain in 84 yo F ABDOMEN:LUNGS BASES: Mild cardiomegaly.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: IVC filter present.BOWEL, MESENTERY: Colonic diverticulosis with mild wall thickening seen involving sigmoid colon. Findings may be seen in setting of acute diverticulitis. Underdistention versus thickening of portions of small bowel and gastric antrum, correlate clinically for gastroenteritis. No secondary signs of acute appendicitis. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BONES, SOFT TISSUES, OTHER: Small simple pelvic ascites. Small fat containing left sided Bochdalek hernia. | 1. Colonic diverticulosis with mild wall thickening seen involving sigmoid colon, small adjacent pelvic ascites. Findings may be seen in setting of mild acute diverticulitis. Followup to resolution recommended to exclude underlying neoplastic process. 2. Underdistention versus thickening of portions of small bowel and gastric antrum, correlate clinically for possibility of gastroenteritis. |
Generate impression based on findings. | Female 62 years old; Reason: Evaluate for obstruction, appendicitis, ischemia, diverticulitis History: abdominal pain, n/v, (+) lactate (reportedly now trending downward) ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Hepatic steatosis with sparing seen near gallbladder fossa. Gallbladder unremarkable, no evidence of acute cholecystitis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Calcification containing 4.3 x 3.1 cm right adrenal mass. Additional indeterminant 1.7 x 1.6 cm left adrenal lesion seen, image 36 series 3.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerotic disease. Visualized celiac and superior mesenteric arteries patent. Contrast opacification of inferior mesenteric artery.BOWEL, MESENTERY: Left-sided bowel postsurgical sequela and surgical clip. Adhesed appearance of colon in right mid to upper abdomen, may be postoperative in etiology, no evidence of bowel obstruction. Small fluid alongside right colon, see coronal image 28 series 80268. Mild ascending colon wall thickening at this level. No evidence of pneumatosis. Normal appendix. Small sliding type hiatal hernia.PELVIS:UTERUS, ADNEXA: Lobulated fibroid uterus. BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted. | 1. Small fluid alongside right colon with mild ascending colon wall thickening at this level. Findings nonspecific, may be seen in setting of a focal acute colitis, may be of infectious or inflammatory etiology, ischemic etiology not entirely excluded. 2. Bilateral indeterminate adrenal lesions, right larger than left, for which followup with dedicated contrast enhanced crosssectional imaging using adrenal protocol recommended to exclude underlying neoplastic process.3. Fibroid uterus, would be better assessed with dedicated sonography. |
Generate impression based on findings. | Reason: Evaluate for hydrocephalus s/p SAH History: SAH The patient is status post right-sided craniotomy for anterior communicating artery aneurysm clip placement. Intraventricular blood is no longer visible. There is no evidence for ventriculomegaly.There is hypodensity present along the anterior aspect of the right temporal lobe as well as the gyrus rectus bilaterally and the a small portion of the medial aspect of the left frontal lobe extending to the cingulate gyrus and superior frontal gyrus. Another hypodense focus is present along the right caudate nucleus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the left maxillary sinus more than the right and the frontal sinuses The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.The lateral ventricles are stable and non-enlarged.2.Status-post recent craniotomy for anterior communicating artery aneurysm clip placement.3.Hypodensities along the anterior aspect of the right temporal lobe as well as the inferomedial aspects of the frontal lobes, right caudate nucleus and the medial left frontal lobe are present. One possibility includes that this reflects ischemic insult. This is stable since the prior exam. |
Generate impression based on findings. | convulsion No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion. |
Generate impression based on findings. | unconsciusness There is about 30mm sized CSF space enlargement superior aspect of the vermis without mass effects indicating possible diagnosis of arachnoid cyst, partial vermian agenesis, prior vermian stroke with encephalomalacia or vermis mass with low attenuation (least likely).Brain MRI with and without contrast is recommended for further imaging evaluation.There is no evidence of acute ischemic or hemorrhagic lesion. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | About 30mm sized low attenuation lesion on the superior aspect of vermis. Differential diagnosis include arachnoid cyst, partial vermian agenesis, post-stroke encephalomalacia or tumorous condition. Brain MRI with and without contrast is recommended.No evidence of acute ischemic or hemorrhagic lesion.This information with discussed with an ER attending at the time of this dictation. |
Generate impression based on findings. | 26-year-old male with ALL, neutropenia. Now with right shoulder anterior pain. Rule out dislocation/fracture. I see no fracture or malalignment. I see no specific findings to account for the patient's shoulder pain. Right basilar lung opacity has been described in a previous chest radiograph report. | No fracture, dislocation, or other specific findings to account for the patient's shoulder pain. |
Generate impression based on findings. | Back and rib pain. Rule out fracture. Three views of the ribs are provided. Bilateral mild rib deformities, left greater than right, indicate old healed fractures, but I see no acute fracture. The bones appear slightly demineralized. Deformity of the right proximal humerus is incompletely imaged on this study but may reflect prior trauma as well. Surgical clips overlie the midabdomen. There is an 8-cm ovoid opacity that appears to be associated with the surgical clips, and therefore may be postoperative in etiology; CT or ultrasonography may be considered for further evaluation if clinically warranted. A right-sided central venous access device is noted with its tip overlying the superior vena cava. Please refer to the accompanying chest radiograph report for details regarding the lungs, including left basilar consolidation and possible pleural effusion. Five views of the lumbar spine are provided. The bones appear demineralized. There are mild compression fractures of T12, L1, L2, and possibly L4 and L5, of indeterminate age. Spinal alignment is within normal limits, and intervertebral disk spaces are preserved. There is contrast within the urinary bladder. A surgical clip overlies the right hemipelvis. There is calcification of the distal abdominal aorta. | Vertebral body compression fractures of indeterminate age other findings as described above. Please refer to the accompanying chest radiograph report for details regarding the lungs, including left basilar consolidation and possible pleural effusion. |
Generate impression based on findings. | cerebrovascular accident No evidence of acute ischemic or hemorrhagic lesion.Patchy low attenuations on bilateral periventricular white matter indicate non specific small vessel ischemic disease.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion.Non specific small vessel ischemic disease. |
Generate impression based on findings. | CoughVIEWS: Chest AP and lateral 2/22/15 Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. Peribronchial wall thickening with subsegmental atelectasis in the right upper lobe. No pleural effusion or pneumothorax. | Bronchiolitis or reactive airway disease. |
Generate impression based on findings. | History of right lung collapseVIEW: Chest AP 2/23/15 ET tube tip below thoracic inlet and above the carina. Cardiothymic silhouette normal. Patchy atelectasis in the right upper lobe and left lower lobe. No pleural effusion or pneumothorax. | Patchy atelectasis bilaterally without focal pneumonia. |
Generate impression based on findings. | Crush injury. Caught in door.VIEWS: Right hand PA, right thumb AP/lateral (3 views) 02/22/15 Soft tissue swelling is present around the distal phalanx of the long. The bones are normal in appearance. No fracture is identified. | Soft tissue injury. |
Generate impression based on findings. | Decreased breath soundVIEW: Chest AP 2/22/15 ET tube tip at the level of the thoracic inlet. Cardiothymic silhouette normal. Right lung collapse has resolved in the interval. Minimal patchy atelectasis left lower lobe. No pleural effusion or pneumothorax. | Right lung collapse resolved in the interval. |
Generate impression based on findings. | 56 year old female with with tachycardia and hypotension, evaluate for intra-abdominal abscess. ABDOMEN:LUNG BASES: Left lower lobe pulmonary mass (series 4, image 11) measures 1.7 x 3.1 cm, measured 1.6 x 2.7 cm previously when similar measurement technique used. New small left and moderate right pleural effusion with associated basilar atelectasis/consolidation.LIVER, BILIARY TRACT: No focal hepatic lesion. Mild biliary ductal prominence similar to prior.SPLEEN: No significant abnormality notedPANCREAS: Atrophic pancreas. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonobstructive punctate right renal calyceal calculi. Left renal subcentimeter low attenuation lesions too small to characterize. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia. Postoperative changes of Roux-en-Y gastric bypass are again identified. A loop colostomy with fat/mesentery-containing parastomal hernia is identified in the left lower abdomen, colostomy bowel underdistended, making evaluation for wall thickening suboptimal, no adjacent inflammation seen. The right lower quadrant ileal conduit is again identified. The right anterior abdominal wall is thinned with loops of small bowel close to the skin surface. Normal caliber bowel without evidence of obstruction. A small amount of new mesenteric fluid is present without loculated fluid collections to suggest abscess.BONES, SOFT TISSUES: Diffuse anasarca, increased from prior.PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postoperative changes of Roux-en-Y gastric bypass are again identified. A loop colostomy with fat/mesentery-containing parastomal hernia is identified in the left lower abdomen. The right lower quadrant ileal conduit is again identified. The right anterior abdominal wall is thinned with loops of small bowel close to the skin surface. Normal caliber bowel without evidence of obstruction. A small amount of new mesenteric fluid is present without loculated fluid collections to suggest abscess.Low lying rectum could reflect prolapse. BONES, SOFT TISSUES: Diffuse anasarca, increased from prior. Orthopedic fixation of left proximal femur appearing similar to prior. | 1.No intra-abdominal abscess identified. 2.Increase in size of left lower lobe pulmonary mass, while inflammatory/infectious etiology a consideration, neoplastic lesion not entirely excluded. 3.New right greater than left pleural effusions with associated compressive atelectasis/consolidation.4.Diffuse anasarca, increased from prior. |
Generate impression based on findings. | Female 75 years old Reason: evaluate for bowel obstruction History: distention, vomiting with hx of SBO 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: Dilated loops of small bowel with transition point in the left hemipelvis (series 3, image 89). There is fecalization of stool material in the small bowel immediately proximal to the transition point. In the right upper quadrant there is a fluid collection near the gallbladder fossa which likely represents a neobladder with stoma near the umbilicus. The duodenum does not cross the midline and the SMV is deviated leftward, raising suspicion for intestinal malrotation.BONES, SOFT TISSUES: Osteopenia with degenerative changes of thoracic spine.PELVIS:UTERUS, ADNEXA: Surgical clips in the pelvis status post hysterectomy.BLADDER: Surgical clips in the pelvis status post cystectomy.LYMPH NODES: Subcentimeter retroperitoneal nodes.BOWEL, MESENTERY: Postsurgical changes in a patient with ulcerative colitis from prior colon resection with anastomosis in the midabdomen.BONES, SOFT TISSUES: Mild degenerative changes of the lumbar spine.OTHER: Trace pelvic fluid. | Findings consistent with small bowel obstruction with transition point in the left hemipelvis as above. |
Generate impression based on findings. | Increased work of breathingVIEW: Chest AP 2/22/15 Cardiothymic silhouette normal. Patchy atelectasis in the right upper lobe, right middle lobe and left lower lobe. No pleural effusion or pneumothorax. | Bronchiolitis or reactive airway disease. |
Generate impression based on findings. | 50 year old female with painless jaundice, evaluate for biliary dilatation or pancreatic mass. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Cholelithiasis. There is marked gallbladder wall thickening. The hepatic parenchyma adjacent to the gallbladder is heterogenous. Additional geographic areas of low-attenuation within the liver are present. Enlarged portocaval and gastrohepatic lymph nodes are present. For reference, a portocaval lymph node (series 5, image 46) measures 2.2 cm in short axis. There is marked attenuation of the portal vein due to periportal adenopathy.Mild intrahepatic biliary ductal dilatation.SPLEEN: Nonspecific low-attenuation cystic lesion (series 5, image 36) measures 1.6 x 1.4 cm. PANCREAS: No pancreatic duct dilatation or discrete pancreatic lesion.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is a large irregularly shaped staghorn calculus in the right renal pelvis with additional small calculi. There is associated moderate hydronephrosis. There are areas of cortical thinning extending to the renal capsule.RETROPERITONEUM, LYMPH NODES: Portocaval and gastrohepatic lymphadenopathy. BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Lobular morphology of the uterus likely due to fibroids.BLADDER: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality noted | 1.Cholelithiasis with marked gallbladder wall thickening. Heterogeneity of the adjacent liver parenchyma as well as significant portacaval/gastrohepatic lymphadenopathy. Findings may reflect complicated acute or acute on chronic cholecystitis with adjacent hepatic microabscesses versus metastatic gallbladder cancer, please correlate with patient's clinical history/laboratory values and refer to subsequent MRI exam for additional details. 2.Heterogenous appearance of the liver due in part to underlying hepatic steatosis. 3.Right-sided obstructive uropathy, right renal staghorn renal calculus with associated moderate hydronephrosis, cortical thinning suggests an element of chronicity. |
Generate impression based on findings. | Abdominal painVIEW: Abdomen AP 2/22/15 G-tube in place. Feeding tube has been removed in the interval. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 75 years, Male. Reason: ro ileus, obstruction History: abdominal pain, Radiodensity projects over the right lower quadrant may represent an calcified lymph node, residual contrast material, or a diverticulum with radiodense debris. Additional radiodensity in the left upper quadrant.Nonobstructive bowel gas pattern. Desiccated stool within the rectum and descending colon. Left lower lobe opacity. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | History of spinal fusionVIEW: Chest AP 2/23/15 ET tube, NG tube, right PICC and posterior spinal fusion rods again noted. Cardiothymic silhouette normal. Patchy atelectasis in the right upper lobe, right middle lobe and left lower lobe minimally increased in the right upper lobe. Blunting of the costophrenic angles likely to represent small bilateral pleural effusions. | Right upper lobe atelectasis has increased in the interval. |
Generate impression based on findings. | 64-year-old male with history of necrotizing pancreatitis, evaluate collections. ABDOMEN:LUNG BASES: Large left and trace right pleural effusion with associated compressive atelectasis appearing similar to prior. Improving additional basilar subsegmental opacities.LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality notedPANCREAS: Again seen findings of necrotizing pancreatitis with associated peripancreatic fat stranding and lymphadenopathy.Collection within the lesser sac (coronal series, image 67) measures 6.9 x 7 .2 cm in the coronal plane, previously 5.8 x 7.8 cm and again mostly contains air. The previously seen anterior percutaneous catheter has been removed.A new posterior approach percutaneous drain has been placed with the tip in the large necrotic air and fluid filled collection in the region of the pancreatic body and tail (series 4, 64) which measures 5.2 x 14.3 cm, previously 5.9 x 13.1 cm in the axial dimension. Multiple catheters extend from the gastric body to the collections, similar to prior. A pancreatic stent is unchanged in position.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: IVC filter. IVC is collapsed, similar to prior. BOWEL, MESENTERY: Enteric tube with tip just distal to the ligament of Treitz. Rectal tube. Normal caliber bowel without evidence of obstruction. Scattered small and large bowel wall thickening likely reactive. Resolved cecal pneumatosis. BONES, SOFT TISSUES: Mild degenerative changes are unchanged.OTHER: Moderate abdominopelvic ascites, similar to prior. Scattered foci of intraperitoneal air similar to prior and thought to be related to the necrotizing pancreatitis. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedBOWEL, MESENTERY: Enteric tube with tip just distal to the ligament of Treitz. Rectal tube. Normal caliber bowel without evidence of obstruction. Scattered small and large bowel wall thickening likely reactive. Resolved cecal pneumatosis. BONES, SOFT TISSUES: Mild degenerative changes are unchanged.OTHER: Moderate abdominopelvic ascites, similar to prior. | 1.Necrotizing pancreatitis. Interval removal of one percutaneous drain and placement of another percutaneous drain, cyst gastrostomy placement. Large necrotic air and fluid-filled peripancreatic collections appear similar to prior.2.Interval improvement in cecal pneumatosis. Scattered bowel wall thickening likely reactive.3.Stable moderate abdominopelvic ascites.4.Large left and trace right pleural effusion with associated compressive atelectasis appearing similar to prior. Improving additional basilar subsegmental opacities. |
Generate impression based on findings. | 14-year-old female with pain, evaluate for elbow fractureVIEWS: Right elbow, AP, oblique, and lateral (3 views) 2/22/15 20:11 Alignment is anatomic. The osseous structures appear normal for the patient's age. No fracture or joint effusion. | Normal examination. |
Generate impression based on findings. | Pain and history of limp. Rule out avascular necrosis.VIEWS: Pelvis AP/frog leg (two views) 02/22/15 The femoral head ossification centers are symmetric. They are well directed into normally formed acetabula. No fracture is seen.A moderate amount of feces is noted in the colon in the right lower quadrant. | Normal examination. |
Generate impression based on findings. | 15-year-old female with pain, evaluate for fracture or dislocationVIEWS: Left ankle, AP, oblique, and lateral (3 views) 2/22/15 21:49 Soft tissue swelling about the lateral ankle. Small joint effusion. The ankle mortise is intact. No fracture or malalignment. | Soft tissue swelling and small joint effusion without fracture or malalignment. |
Generate impression based on findings. | 29 year old female with hematuria and right flank pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Splenic calcifications compatible with prior granulomatous disease.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No hydronephrosis or nephrolithiasis. No hydroureter or ureteral calculi.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. Status post appendectomy. PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedBOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. Status post appendectomy. BONES, SOFT TISSUES: No significant abnormality notedOTHER: Left pelvic surgical clips with adjacent scarring likely related to prior inguinal hernia repair. | 1.No nephrolithiasis or hydronephrosis.2.No other specific findings to account for the patient's pain. |
Generate impression based on findings. | Pain, limited range of motion. Evaluate right hip for chronic dislocation. Prior total knee arthroplasty. Left knee pain and stiffness. Two views of the right hip are provided. There is superolateral dislocation of the femoral component of the patient's total hip arthroplasty relative to the acetabular component.The AP view the pelvis shows the aforementioned right total hip arthroplasty dislocation. The bones appear demineralized. There is chronic-appearing deformity of the left hip, with flattening of the superomedial aspect of the femoral head and associated obliquity of the acetabular roof, which may reflect prior surgery or longstanding arthritic remodeling. Evaluation of the sacrum is limited by overlying bowel contents. Degenerative arthritic changes affect the visualized lower lumbar spine.Four views of the left knee show components of a total knee arthroplasty device situated in near anatomic alignment without radiographic evidence of hardware complication. There is heterotopic ossification within the proximal patellar tendon adjacent to the inferior pole of the patella. | Dislocated right total hip arthroplasty device and other findings as above. |
Generate impression based on findings. | Cough and chest pain.VIEWS: Chest PA/lateral (two views) 02/22/15 Right central line tip is in SVC/right atrial junction.Cardiac silhouette size is normal. Patchy opacities are present in both lungs and are a new finding in the interval. Lung metastases are not well visualized. Cardiac silhouette size is normal. | Development of multiple patchy opacities most likely due to infection. |
Generate impression based on findings. | 72 years, Female. Reason: passage of capsule History: sp capsule endoscopy Greater than average stool burden. Capsule projects over the right lower quadrant and is likely within the cecum/ascending colon. Nonobstructive bowel gas pattern. | Capsule is likely within the cecum/ascending colon. |
Generate impression based on findings. | 41 year old female with history of lymphoma now with recurrent fevers. CHEST:LUNGS AND PLEURA: Mild dependent atelectasis. No suspicious nodules or masses.MEDIASTINUM AND HILA: Chest port and left-sided central venous catheter with catheter tips at the SVC atrial junction. No hilar or mediastinal lymphadenopathy.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: The gallbladder is mildly distended but without definite adjacent inflammatory changes. No focal hepatic lesion or biliary ductal dilatation.SPLEEN: Mild splenomegaly appearing similar to prior.PANCREAS: The pancreas is no longer enlarged.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No retroperitoneal lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Previously seen subcutaneous soft tissue nodules in the back have nearly resolved.PELVIS:UTERUS, ADNEXA: Bilateral tubal ligation clips are noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted. | 1.Mildly distended gallbladder, nonspecific and may be further evaluated with ultrasound to exclude acute cholecystitis if there is clinical concern.2.No lymphadenopathy. Mild splenomegaly similar to prior. 3.Pancreas is no longer enlarged. |
Generate impression based on findings. | 12-day-old male, intubated, evaluate ETTVIEW: Chest, AP, abdomen AP (two views) 2/23/15 0:51 ETT tip is below the thoracic inlet. UVC tip in the right atrium. UAC tip at T7. NG tube tip at the EG junction. Abdominal surgical drain tip in the left upper quadrant. Coarse bilateral pulmonary opacities and subsegmental atelectasis appear similar to the prior exam. The cardiothymic silhouette is normal. Paucity of bowel gas. | ETT tip just below the thoracic inlet. NG tube tip at the EG junction. |
Generate impression based on findings. | Respiratory failureVIEW: Chest AP 2/23/15 Left upper extremity PICC with tip in the SVC. Cardiothymic silhouette at the upper limits of normal. Patchy atelectasis left lower lobe. No pleural effusion or pneumothorax. | Patchy atelectasis left lower lobe. |
Generate impression based on findings. | Female 75 years old Reason: s/p reduction History: s/p reduction. Overlying cast limits evaluation of fine bone detail. The previously seen tibiotalar dislocation has been reduced to near anatomic alignment. There is minimal displacement of the previously seen distal fibular and posterior malleolar fracture fragments. | Reduction of ankle fracture and dislocation as described above. |
Generate impression based on findings. | 24-year-old male with pleuritic chest pain. Evaluate for pulmonary embolism. PULMONARY ARTERIES: Small filling defect in the posterior segmental branch of the right lower lobe pulmonary artery (series 80424, image 171). Main pulmonary artery measures up to 2.5 cm in caliber, within normal limits. No evidence of right heart strain or reflux of contrast into the IVC.LUNGS AND PLEURA: Again seen are innumerable bilateral pulmonary nodules not significantly changed with redemonstration of right upper lobe cavity lesion. There is interval development of additional cavitary lesions in the right upper lobe (series 8060, image 98). Previously referenced left lower lobe nodule measures up to 1.1 cm (series 8060, image 110) previously 0.8 cm. Previously reference right lower lobe nodule measures 1.7 cm x 1.4 cm (series 8060, image 181) previously 1.7 cm x 1.8 cm on study dated 7/8/2014.MEDIASTINUM AND HILA: Reference right paratracheal lymph node now measures 0.7 cm x 0.7 cm (series 80424, image 72) previously 0.8 cm x 0.6 cm. No additional axillary, mediastinal or hilar lymphadenopathy. Normal sized heart without pericardial effusion.CHEST WALL: Right chest wall port catheter tip at the cavoatrial junction. Again seen is a soft tissue density in the left supraclavicular region (series 80424, image 30) likely a lymph node and is not significantly changed.UPPER ABDOMEN: Previously referenced liver lesion (series 80424, image 232) is difficult to accurately measure given this is a dedicated PE protocol study. | 1. Small filling defect compatible with pulmonary embolism in the posterior branch of the right lower lobe pulmonary artery. 2. No significant interval change in pulmonary metastatic disease, however there are additional cavitary lesions in the right upper lobe. |
Generate impression based on findings. | Male 62 years old Reason: r/o foreign body. History: laceration from glass at 2-3 mcp area. We see no radiopaque foreign body. There is deformity of the fifth metacarpal neck indicating an old healed boxer's fracture. | No radiopaque foreign body evident. |
Generate impression based on findings. | 53-year-old male with worsening abdominal pain, vomiting and diarrhea; evaluate for mesenteric ischemia. ABDOMEN:LUNG BASES: Mild basilar atelectasis. LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate right renal nonobstructive calyceal calculi. No hydronephrosis or obstructing renal calculi.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. No abnormal bowel wall thickening. Diverticulosis without evidence of diverticulitis. Though phase of contrast not optimal for assessing arteries, celiac artery and SMA appear patent. BONES, SOFT TISSUES: Degenerative changes of the thoracolumbar spine including minimal wedging of several thoracolumbar vertebral bodies. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. No abnormal bowel wall thickening. Diverticulosis without evidence of diverticulitis. Though phase of contrast not optimal for assessing arteries, celiac artery and SMA appear patent. BONES, SOFT TISSUES: No significant abnormality noted | 1.Punctate right renal nonobstructive calyceal calculi without hydronephrosis.2.Diverticulosis without diverticulitis. 3.No additional specific findings to account for the patient's symptoms. |
Generate impression based on findings. | Male 70 years old Reason: evaluate for Fournier's History: erythematous scrotum, perirectal abscess, WBC 27, in DKA The exam is suboptimal secondary to lack of intravenous contrast which limits sensitivity for visceral and vascular pathology.ABDOMEN:LUNG BASES: Motion artifact limits evaluation of fine pulmonary parenchymal detail. Within these limitations, there is an irregularly-shaped lesion in the right lower lobe measuring 1.2 x 1.2 cm (series 5, image 21), previously measuring 1.3 x 0.6 cm.LIVER, BILIARY TRACT: Layering gallstones without evidence of cholecystitis. Punctate calcifications consistent with prior granulomatous disease.SPLEEN: Splenic granulomata.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Nonspecific bilateral perinephric fat stranding without hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis without diverticulitis.BONES, SOFT TISSUES: Evaluation is suboptimal without intravenous contrast. Within these limitations, there is extensive edema and fat stranding in the medial gluteal soft tissue on the right which extends to the right ischioanal fossa. There is no discrete fluid collection delineated. There are punctate foci of air intervening between the soft tissue planes of the perineum and right lower extremity, evaluation for tiny soft tissue gas foci suboptimal but no definite focus seen, punctate hypoattenuating foci appear to be fat attenuation. | 1.Exam is suboptimal secondary to lack of intravenous contrast. Within these limitations, there is edema and fat stranding in the right medial gluteal soft tissues without a discrete fluid collection or definite evidence of Fournier's gangrene. 2.Interval increase in size of the irregularly-shaped right lower lobe lung nodule, which may be infectious/inflammatory in etiology, however, malignancy cannot be excluded. Recommend close interval follow-up. |
Generate impression based on findings. | Reason: further eval bilateral airspace opacity History: see CXR LUNGS AND PLEURA: Bilateral patchy and confluent areas of groundglass, with small areas of consolidation.Few scattered irregular cystic spaces with poorly defined walls. Mild traction bronchiectasis may indicate chronic underlying lung disease.No pleural effusions.No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. No visible coronary artery calcification.Scattered non-enlarged mediastinal and hilar lymph nodes.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Bilateral patchy and confluent areas of groundglass. Differential considerations include diffuse hemorrhage as well as inflammatory process, including vasculitis. Scattered irregular cystic spaces and traction bronchiectasis may indicate chronic underlying lung disease. |
Generate impression based on findings. | Evaluate pneumothoraxVIEW: Chest AP 2/23/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. The umbilical venous catheter tip in the IVC. Left chest tube in place. Cardiothymic silhouette normal. Diffuse atelectasis bilaterally not significantly changed. No pleural effusion or pneumothorax. | No evidence of pneumothorax. |
Generate impression based on findings. | Pain. Evaluate left thumb. Again seen are two orthopedic screws affixing the first metacarpophalangeal joint in near anatomic alignment. I see no hardware complications. The articulation remains visible at this time. Density adjacent to the articulation seen on the prior study, presumably representing bone graft, is no longer visualized. Moderate osteoarthritis affects the interphalangeal joint of the thumb as well as the interphalangeal joints of the fingers. The trapezium has been surgically resected. | Postoperative changes of first metacarpophalangeal joint fusion other findings as above. |
Generate impression based on findings. | 38 day old male with congestion, rule out pneumoniaVIEWS: Chest AP/lateral (two views) 2/23/15 2:56 Bronchial wall thickening with posterior upper lobe subsegmental atelectasis suggesting bronchiolitis. No evidence of pneumonia or pleural effusion. The cardiothymic silhouette is normal. The cardiac apex, aortic arch and stomach are left-sided. | Bronchiolitis without evidence of pneumonia. |
Generate impression based on findings. | Male 56 years old Reason: r/o fx/dislocation History: anterior pain and instability after 7ft fall and landed on feet. There is soft tissue swelling about the knee and mild osteoarthritis. We see no fracture or malalignment. Tiny densities within the intercondylar notch may represent small intra-articular ossicles, but we see no donor site to suggest an acute fracture fragment. Soft tissue swelling limits evaluation of the extensor mechanism. There is slight depression of the articular surface of the lateral femoral condyle which may simply reflect normal anatomy for this patient, but can be seen in association with anterior cruciate ligament tears. | Soft tissue swelling and slight depression of the articular surface of the lateral femoral condyle. These findings are nonspecific but if there is clinical concern for internal derangement such as an anterior cruciate ligament tear, MRI is recommended. |
Generate impression based on findings. | 59 years, Male. Reason: New dobhoff placement History: Dobbhoff placement Multiple support devices projected over the abdomen are unchanged in position. Nonobstructive bowel gas pattern. Enteric feeding tube with tip projected over the gastric body. Dobbhoff catheter is looped in the stomach with tip projected over the gastric fundus.Catheter tip projected at the bladder. | Enteric feeding tube with tip projected over the gastric body. |
Generate impression based on findings. | Elevated CO2VIEW: Chest AP 2/23/15 Tracheostomy tube in place. NG tube tip in the stomach. Left neck PICC unchanged. Cardiothymic silhouette normal. Right upper lobe atelectasis new from prior study. Patchy atelectasis in the right lower lobe. No pleural effusion or pneumothorax. | Right upper lobe atelectasis new from prior study. |
Generate impression based on findings. | Female 56 years old Reason: evaluate for injury History: pain after tripping. The bones appear slightly demineralized. There may be a small joint effusion, but we see no fracture malalignment. | Possible small joint effusion. No fracture is evident. |
Generate impression based on findings. | Pain. Infection with unclear etiology. Two views of the right foot are provided. The bones appear demineralized. There is perhaps mild soft tissue swelling along the dorsal aspect of the forefoot, but I see no underlying osteolysis to suggest osteomyelitis. There is suggestion of a pes cavus deformity. Plantar and posterior calcaneal spurs may not be of any current clinical significance. Arterial calcifications are noted in the soft tissues.Two views of the right ankle are provided. The bones appear slightly demineralized. There is perhaps mild soft tissue swelling, but I see no specific radiographic features of osteomyelitis.Four views of the mandible are provided. Note is made of poor dentition with multiple dental fillings and dental caries. I see no specific radiographic features of osteomyelitis of the mandible. If further imaging evaluation is clinically warranted, dedicated dental radiographs or CT may be considered. | Soft tissue swelling of the foot and ankle, poor dentition, and other findings as described above, without specific radiographic features of osteomyelitis. |
Generate impression based on findings. | Female 29 years old Reason: R/O FX History: LATERAL ANKLE PAIN AND SWELLING S/P FALL. There is soft tissue swelling, particularly along the lateral aspect of the ankle, but no fracture is evident. | Soft tissue swelling without fracture. |
Generate impression based on findings. | Female 76 years old Reason: diverticulitis, partial SBO, progression of AAA History: epigastric abdominal pain, history of AAA (4.3x4.5cm), nausea, recent partial SBO ABDOMEN:LUNG BASES: Stable left lower lobe micronodule.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Atrophic head of the pancreas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted. RETROPERITONEUM, LYMPH NODES: Infrarenal abdominal aortic fusiform aneurysm is again seen and not significantly changed in size, measuring 4.5 x 4.4 cm (series 3, image 74), previously 4.5 x 4.3 cm. Extensive atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Interval improvement of dilatation of the small bowel seen on prior exam. There is persistent fecalization of stool material which may be secondary to previously seen small bowel obstruction.PELVIS:UTERUS, ADNEXA: Surgically absent. BLADDER: No significant abnormality noted.BOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis. Low lying rectum which may represent a rectocele. Please correlate clinically. No free fluid in the pelvis.BONES, SOFT TISSUES: Degenerative changes of the lumbar spine. | 1.Interval resolution of partial small bowel obstruction.2.Stable infrarenal abdominal aortic aneurysm. |
Generate impression based on findings. | 2-year-old male, new NG tube placement.VIEW: Abdomen AP (one view) 2/23/15 6:37 NG tube tip and side-port in the stomach. The bowel gas pattern is disorganized but nonobstructive. Left lower lobe pulmonary opacity increased from the prior exam. | NG tube tip and side-port in the stomach. Left lower lobe pulmonary opacity increased from the prior exam. |
Generate impression based on findings. | Abdominal pain. Assess for bowel dysfunction.EXAMINATION: Abdomen AP (one view) 02/22/15 A gastrostomy tube is present. A probe is projected over the rectum. There is a left thoracolumbar curve. Mildly to moderately dilated bile is present in a disorganized pattern. No significant stool is seen. | Dilated bowel. |
Generate impression based on findings. | Female 58 years old Reason: r/o abnormality History: c spine pain. C7 and the cervicothoracic junction are not well seen on the lateral view due to overlying anatomy.The cervical spine is slightly kyphotic. There is moderate degenerative disk disease at C4/C5, C5/C6, and C6/C7 with anterior and posterior vertebral body osteophytes. There is also mild multilevel facet joint osteoarthritis. There is perhaps mild narrowing of the C4/C5 foramen on the left. Apparent narrowing of the neuroforamina of the lower cervical spine on the right, may be accentuated by slightly suboptimal positioning. | Degenerative disk disease and other findings as above. |
Generate impression based on findings. | 36 years, Female. Reason: toxic megacolon, evaluate for ileus History: diarrhea from c diff Nonobstructive bowel gas pattern. Gastrostomy tube tip projects over the mid abdomen. Foley catheter projected over the bladder. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Tachycardia, desaturations. Assess for PE. The comparison chest CT performed on 2/22/2015 demonstrates small bilateral pleural effusions. The ventilation images show minimal delayed activity on single-breath and wash-in images in the bilateral lung bases. There is no abnormal Xe-133 retention during the wash-out phase. The perfusion images show a physiologic distribution of pulmonary perfusion without evidence of any moderate, large, or segmental unmatched perfusion defects. | Very low probability for pulmonary embolism. |
Generate impression based on findings. | 70 years, Female. Reason: 70 yo with previous foreign body ingestion on CT, assess for movement History: foreign body ingestion Vascular calcifications in the pelvis. Sclerotic bone island in the left iliac crest. Greater than average stool burden. Nonobstructive bowel gas pattern. No radiopaque foreign body is identified. | No radiopaque foreign body is identified. Nonobstructive bowel gas pattern. |
Generate impression based on findings. | 43 year old who returns for further evaluation of an oval mass in the right breast. History of breast left surgery in 2012. An ML view and two spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. The suspected mass seen on screening mammography partially disperses on spot compression. No suspicious microcalcifications or areas of architectural distortion in the right breast. ULTRASOUND | High probability benign complicated cyst which is likely an oil cyst related to the patient's surgery. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram with ultrasound is recommended in 6 months. Results and recommendation were discussed with the patient.BIRADS: 3 - Probably benign finding.RECOMMENDATION: 3B - Followup at Short Interval (1-11 Months). |
Generate impression based on findings. | Reason: 3T Scanner, yearly surveillance MRA History: Yearly Aneurysm Surveillance MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no interval change in the wide neck medially directed right paraclinoid ICA aneurysm that measures up to 3 mm.There is no interval change in the wide neck laterally directed left paraclinoid ICA aneurysm that measures up to 3 mm.The ACOMA is small. The left PCOMA is medium size. The right PCOMA is tiny. | 1. Stable bilateral paraclinoid aneurysms. |
Generate impression based on findings. | Female; 45 years old. Reason: Evaluate for progression of metastatic disease; compare to previous scan History: Sigmoid colon adenocarcinoma CHEST:LUNGS AND PLEURA: Again seen throughout both lungs are multiple pulmonary nodules. These appear stable in size and number compared to the CT from January 2015. The reference right lower lobe pulmonary nodule measures 0.8 x 0.6 cm (series 5/77), previously 0.8 x 0.7 mm.No pleural effusion or evidence of infection.MEDIASTINUM AND HILA: Right chest port, tip in the SVC.Stable slightly prominent mediastinal lymph nodes which are not enlarged by size criteria.Heart size is within normal limits. There is no pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Postoperative changes of right trisegmentectomy and cholecystectomy.Redemonstration of multiple hypodense lesions throughout the remaining left lobe of the liver. The confluent mass in the former location of the porta hepatis measures 2.3 x 3.4 cm (series 3/91), previously 2.7 x 3.9 cm and appears to compress possibly invade the portal vein which is patent distally. This is similar in appearance to the prior exam. The second reference lesion more inferiorly measures 1.4 x 1.2 cm (series 3/11), previously 1.6 x 1.6 cm.SPLEEN: Hypodensity at the splenic hilum is again seen, it measures 1.8 x 1.9 cm (series 3/90), previously 2.5 x 2.3 cm. Additional, new wedge shaped hypodensities are seen in the periphery of the spleen.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Multiple enlarged retroperitoneal lymph nodes are redemonstrated. The reference left periaortic node measures a 2.3 x 1.5 cm (series 3/119), previously 1.9 x 1.3 cm.A hypodense mass, likely nodal metastasis, surrounds the IVC. It is inseparable from the IVC and appears similar to the prior study. The IVC is patent.BOWEL, MESENTERY: Postsurgical changes of bowel resection. No evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No enlarged pelvic lymph nodes.BOWEL, MESENTERY: Postsurgical changes of bowel resection. No evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Interval increase in size of the reference left periaortic lymph node.2.Stable bilateral pulmonary nodules consistent with metastases.3.Enlarged lymph node is again inseparable from the IVC, vascular invasion cannot be excluded. The IVC is patent4.Decrease in size of reference hepatic metastases. Similar appearance of the left portal vein with possible invasion.5.Interval decrease in size of splenic metastasis. 6.New peripheral, wedge shaped hypodensities at the periphery of the spleen have the appearance of infarcts or less likely metastases. Attention to this area on subsequent follow up exams is recommended. |
Generate impression based on findings. | 69 years, Female. Reason: VERIFY PASSAGE OF CAPSULE FROM CAPSULE STUDY History: VERIFY PASSAGE OF CAPSULE FROM CAPSULE STUDY LVAD device in situ. Changes related to prior sternotomy. Pacer leads noted.Two metallic densities projected the right quadrant of the appearance of surgical clips. No evidence of capsule. Nonobstructive bowel gas pattern. | No evidence of capsule. |
Generate impression based on findings. | Male 60 years old Reason: perforated ulcer History: history of peptic ulcer disease p/w severe epigastric pain radiating to back ABDOMEN:LUNG BASES: Bibasilar atelectasis/scarring. No pleural effusions.LIVER, BILIARY TRACT: Hypodense lesion in the dome of the liver which is too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality noted ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Abdominal aorta is normal in caliber.BOWEL, MESENTERY: No extravasation of enteric contrast to suggest perforation. No pneumoperitoneum or pneumatosis. Nonspecific fecalization of stool material in the terminal ileum. Normal appendix. No evidence of bowel obstruction. BONES, SOFT TISSUES: Degenerative changes of the visualized spine.PELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate with punctate calcifications.BLADDER: No significant abnormality notedLYMPH NODES: Scattered subcentimeter retroperitoneal lymph nodes.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of the visualized spine. | No findings to suggest perforated ulcer. No acute findings delineated on CT study to explain patient's epigastric pain. |
Generate impression based on findings. | Cough feverVIEWS: Chest AP and lateral Cardiothymic silhouette normal. Peribronchial wall thickening with subsegmental atelectasis in the right lower lobe and left lower lobe. No pleural effusion or pneumothorax. | Bronchiolitis or reactive airway disease. |
Generate impression based on findings. | Reason: r/o PE History: SOB, tachycardia, BLE swelling PULMONARY ARTERIES: Exam is limited by poor differential contrast opacification of the pulmonary arteries, due to slow contrast flow. No evidence of pulmonary embolism to the lobar level. The main pulmonary artery is normal in caliber.LUNGS AND PLEURA: No suspicious pulmonary nodules or masses.Minimal dependent atelectasis/pleural thickening. Mild mosaic attenuation pattern diffusely. No focal airspace 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: Mild degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1. Somewhat limited exam, without evidence of pulmonary embolism to the lobar level. 2. Mild mosaic attenuation pattern is nonspecific, and may relate to chronic pulmonary emboli.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Female 37 years old Reason: sacral decubitus ulcer History: sacral decubitus ulcer. Evaluation of the sacrum is limited by overlying bowel contents. We cannot confirm or exclude osteomyelitis of the sacrum on the basis of this study. Mild osteoarthritis affects both hips. | Evaluation of the sacrum is limited by overlying bowel contents. We cannot confirm or exclude osteomyelitis. If further imaging is clinically warranted, MRI or CT is recommended. |
Generate impression based on findings. | Again noted are scattered foci of air within the right parapharyngeal space measuring up to 1.1 cm in the axial dimension (series 7, image 21), decreased compared to previous examination; these are likely postoperative in etiology. No focal fluid collections or abscess. There is nonspecific mild parapharyngeal edema which may be postoperative in etiology. No evidence of cellulitis. The parotid and submandibular glands are normal in size and symmetric bilaterally without masses. There are no thyroid masses. There are no nasopharyngeal, oropharyngeal or laryngeal masses identified and there is no airway compromise. The lung apices are clear. There is no clinically significant adenopathy. There are no soft tissue masses. There is an impacted maxillary tooth between the canine and lateral incisor on the left. | Postoperative changes of tonsillectomy with a resolving parapharyngeal air without evidence of fluid collections or abscess. |
Generate impression based on findings. | Female 33 years old Reason: evaluate for injury History: pain s/p trauma. Three views of the left wrist show a transverse fracture through the distal radial metaphysis with minimal dorsal displacement of the distal fracture fragment. | Distal radius fracture as above. |
Generate impression based on findings. | Reason: r/o worsening aneurysms History: hx of multiple aneurysms, 1 s/p clipping. biparietal headache Brain CTA: The patient is status post placement of aneurysm clips along the distal right internal carotid artery. The patient is status post left sided craniotomy probably for removal of a previously noted meningioma.There is a 4-mm aneurysm present at the distal right internal carotid artery. This is directed inferomedially. It is proximal to the clip.There is a 2.5mm x 2mm left carotid terminus aneurysm. This is directed medially.There is a 2mm left communicating segment aneurysm. This is directed posteriorly.There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are intact.There is extracranial origin of the posterior-inferior cerebellar artery bilaterally.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post placement of aneurysm clips along the distal right internal carotid artery. The patient is status post left sided craniotomy probably for removal of a previously noted meningioma.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin. | 1.The patient is status post placement of aneurysm clips along the distal right internal carotid artery.2.There is a 4-mm aneurysm present at the distal right internal carotid artery proximal to the clip. This is not clearly present on the prior angiogram. Conventional angiography may provide additional information if clinically appropriate.3.There is a 2.5mm x 2mm left carotid terminus aneurysm. 4.There is a 2mm left communicating segment aneurysm. 5.Findings were discussed with Dr Lesniak at the time of this interpretation. |
Generate impression based on findings. | Male 30 years old Reason: r/o fracture History: pain, swelling, limited mobility. We have 3 views of the right index finger. The proximal interphalangeal joint is held in slight flexion. There is soft tissue swelling, particularly along the dorsal aspect of the proximal interphalangeal joint. There is questionable disruption of the dorsal cortex of the head of the proximal phalanx, which may represent a fracture fragment donor site, but this is equivocal. Tiny densities within the soft tissues dorsal to the head/neck of the proximal phalanx could represent tiny fracture fragments or possibly small foreign bodies. A couple additional densities are seen dorsal to the distal diaphysis of the proximal phalanx which may represent small additional foreign bodies. | Soft tissue swelling dorsal to the head and neck of the proximal phalanx with tiny densities that may represent a combination of fracture fragments and foreign bodies. Mild cortical irregularity along the dorsal aspect of the head of the proximal phalanx could conceivably represent a donor site, although we cannot entirely exclude the possibility of an early infection if there is an overlying wound. |
Generate impression based on findings. | Male 80 years old Reason: r/o fracture, nerve root compression, mass History: lumbar spine tenderness, LLE radiculopathy There is severe degenerative disk disease at L1/L2 and moderate degenerative disk disease at L2/L3. There is moderate facet joint osteoarthritis at the lower lumbar levels with probable neuroforaminal narrowing at these levels. We see no fracture or focal lesion of bone. Severe osteoarthritis affects the sacroiliac joints. Note is made of a calcified and mildly dilated abdominal aorta. Note is made of a few mildly distended gas-filled loops of small bowel. | Degenerative disk disease and other findings as described above. We see no fracture. |
Generate impression based on findings. | Congenital maldevelopment of the brain, agenesis of the corpus callosum, and significant atrophic changes; these findings are unchanged compared to previous examination. 8mm of cerebellar tonsillar herniation is noted. Scattered extra-axial and parenchymal calcifications are unchanged. Since the prior examination, fluid entrapped by the medially ballooning parenchyma has increased causing expansion of the parenchyma while the surrounding extraaxial fluid collections have decreased in size.Stable position of ventricular shunt catheter tip which enters the interhemispheric fluid collection. No discontinuity of the radiopaque portions of the shunt.No acute intracranial hemorrhage. Mild to moderate mucosal thickening of the right sphenoid sinus. Mild mucosal thickening of the right maxillary and left sphenoid sinuses. | 1.No definite acute intracranial abnormality. 2.Apparent shift in fluid with increased fluid entrapped in the parenchyma in the midline of the brain and decrease in fluid in the extra-axial spaces. No significant interval change in ventriculoperitoneal shunt catheter position. 3.Stable severe dysmorphic changes as above. |
Generate impression based on findings. | There is a questionable nondisplaced fracture of the ramus of the right mandible, best seen on coronal images. There is a small right maxillary polyp and partial opacification of the ethmoid air cells. Otherwise, the frontal, ethmoid, sphenoid, and maxillary paranasal sinuses, the mastoid air cells, and the middle ears are appropriately pneumatized. The nasal septum lies at midline. The imaged intracranial structures and orbits are unremarkable. | Questionable nondisplaced fracture of the ramus of the right mandible. Correlation with physical exam for point tenderness recommended. |
Generate impression based on findings. | 83 years, Male. Reason: Dobbhoff placement/re-positioning History: Dobbhoff placement/re-positioning Dobbhoff catheter is coiled within the stomach with tip projected over the medial gastric fundus. Nonobstructive bowel gas pattern. The pelvis is not imaged. | Dobbhoff catheter is coiled within the stomach with tip projected over the medial gastric fundus. |
Generate impression based on findings. | 28-year-old with left lateral breast mass. A targeted left ultrasound was performed for the patient’s area of concern. There are two benign morphology masses and a cyst. The larger mass is a circumscribed oval hypoechoic mass measuring 2.0 x 1.7 cm. Echogenic foci within the mass may represent calcifications. An additional mass deep to the largest mass measuring 5 x 7 mm is seen. A 7 mm cyst along the superior aspect of the dominant mass is also noted. | Right breast masses at the site of palpable concern, including a 2 cm solid mass which may represent a fibroadenoma. Surgical consultation is recommended. The patient will be seeing Dr. Chhablani later this week. BIRADS: 3 - Probably benign finding.RECOMMENDATION: B - Surgical Consultation. |
Generate impression based on findings. | 63 years, Male. Reason: ng History: ng Study is limited by respiratory motion artifact. Enteric feeding tube with tip projected over the mid gastric body. Nonobstructive bowel gas pattern.Patchy basal lung opacities are better evaluated on chest radiograph same date. The pelvis is not imaged. | Enteric feeding tube with tip projected over the mid gastric body. |
Generate impression based on findings. | 59-year-old male with history of laryngeal cancer and CRT. Redemonstrated are extensive postoperative changes related to laryngectomy, tracheostomy, myocutaneous flap reconstruction, lymph node dissection, voice prosthesis, and postradiation therapy. Heterogeneous, irregular mass lateral to the left carotid artery appear similar to prior measuring 19 x 11 mm. There is no evidence of additional cervical lymphadenopathy by CT size criteria. The salivary and remaining thyroid glands appear normal. The internal jugular veins are not well opacified, unchanged when compared to prior. There are numerous tortuous vessels within the neck likely represent collateral circulation. There is mild mucosal thickening of bilateral maxillary sinuses. There is biapical lung scarring. The visualized intracranial structures are unremarkable. | Postoperative changes with heterogeneous lesion adjacent to the left common carotid appearing similar to prior corresponding to treated tumor recurrence. |
Generate impression based on findings. | Postoperative changes involving the left anterior maxilla and maxillary gingival space with resection of the maxilla and reconstruction with a bone graft. Streak artifact from surgical fixation obscures visualization of the gingival space. Unchanged infiltration and thickening of the overlying soft tissues of the left anterior face, likely postsurgical in etiology. Surgical clips along bilateral mandible and submandibular spaces. No pathological adenopathy by size criteria is noted. For example, right level 1a lymph node measures approximately 5 mm (series 8, image 45), previously measuring 6 mm, is likely reactive in etiology.The parotid and submandibular glands are normal in size and symmetric bilaterally without masses. There are no thyroid masses. There are no nasopharyngeal, oropharyngeal or laryngeal masses identified and there is no airway compromise. The lung apices are clear. There is no clinically significant adenopathy. Moderate mucosal thickening of the left maxillary sinus. | 1.Streak artifact from surgical hardware limits evaluation as above and direct visual inspection of the gingival space is recommended.2.Postoperative changes involving the left anterior maxilla and maxillary gingival space. 3.No pathological adenopathy. |
Generate impression based on findings. | Reason: Evaluate for pneumonia History: new productive cough, elevated WBC, low-grade fevers. But, pt also has advanced heart failure. LUNGS AND PLEURA: Mild septal prominence and bilateral small pleural effusions, right greater than left.Patchy areas of ground glass and consolidation bilaterally, right greater than left.MEDIASTINUM AND HILA: The heart is enlarged, without pericardial effusion. Severe coronary artery calcifications. ICD leads terminate near the right atrium and cardiac apex.Scattered prominent mediastinal and hilar lymph nodes, likely nodal edema.CHEST WALL: Left chest AICD.Degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Mild septal prominence and bilateral pleural effusions may reflect pulmonary edema, likely related to CHF. Patchy areas of ground glass and consolidation likely represent superimposed diffuse infectious process or hemorrhage. |
Generate impression based on findings. | Male; 69 years old. Reason: PE History: RV dilatation on US, shortness of breath, hypotension. PULMONARY ARTERIES: No evidence of acute PE. Enlarged normal main pulmonary artery caliber.LUNGS AND PLEURA: There has been interval progression of basilar and peripherally predominant subpleural reticulation, honeycombing, and traction bronchiectasis. Findings are compatible with worsening fibrotic interstitial lung disease, most likely UIP. Small interspersed areas of consolidation are also seen within the right lung. Small left pleural effusion.MEDIASTINUM AND HILA: Enlargement of the right heart chamber and straightening of the intraventricular septum with small pericardial effusion. Mediastinal lymphadenopathy is again noted. Reference high right paratracheal lymph node now measures 15 mm, previously 9 mm (series 8, image 54). Tortuous and ectatic ascending aorta. Moderate coronary calcifications.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Reflux of contrast into the hepatic veins and IVC. | 1.No evidence of acute pulmonary embolism.2.Findings compatible with right heart strain as discussed above.3.Interval worsening of chronic interstitial lung disease, most likely UIP.4.Contrast extravasation event; please see details in technique section above.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Positive. |
Generate impression based on findings. | Ms. Williams is a 34 year-old female with a personal history of left breast lumpectomy in February 2013 for triple negative IDC. Patient did not receive any chemotherapy or radiation therapy. She had a recent MRI that showed linear non-mass-enhancement extending anterior to the lumpectomy site. She presents today for MR-guided biopsy of that area. On subtraction images, linear non-mass-enhancement was identified in the left upper outer breast, extending anterior to the known lumpectomy site. This was chosen as the target.PROCEDURE:Coordinates of the central portion of the biopsy target were determined on the monitor. The approach was from lateral to medial direction. Overlying skin was cleansed with chlorhexidine and superficial and deep anesthesia were obtained with lidocaine. A 9-gauge introducer with stylet was advanced to the target lesion. Subsequent MR images confirmed satisfactory position of the tip of the introducer prior to the biopsy. A 9-gauge needle was then advanced to the target lesion and biopsy was performed using a Suros vacuum assisted device. A total of 6 cores were obtained. Post procedural MR images show a small hematoma at the biopsy site. Linear non-mass enhancement continued to be present just posterior to the needle trough. As a result, the needle was slightly withdrawn and 4 additional cores were obtained. A total of 10 cores were obtained and they were sent to Pathology with an accompanying history sheet. An ATEC clip was placed into the center of the target.Following the removal of the grid, pressure was held at the biopsy site until bleeding subsided. The skin wound was closed with a Steri-Strip and pressure bandage and ice pack were applied to the biopsy site.Specimen radiograph was obtained for documentation. No calcifications were seen in the specimen radiograph.The patient tolerated this procedure well and underwent a left unilateral mammogram CC and ML views to locate the percutaneously placed clip. The clip is placed at the 2 o'clock position with no evidence of any complications due to the procedure. The patient tolerated this procedure well and left the radiology suite in stable condition. The MR procedure was performed by Dr. Sheth under direct supervision of Dr. Abe who was present throughout the procedure. | Successful MR guided core needle biopsy of the left breast 2 o'clock at the site of linear non-mass enhancement with successful clip placement. BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on findings. | There is new moderate compression deformity involving L3 with approximately 50% height loss which is likely acute to subacute. A new lytic lesion involving the left L5 vertebral body and pedicle with resultant mild effacement of the L5/S1 foramina and encroachment on the left lateral recess. Additionally, there are new lytic lesions involving the right iliac wing and the left sacral ala. Chronic severe compression deformity of L1 with mild retropulsion of the osseous fragment is unchanged. There is cement in the right neural foramina at L1/2. T12/L1: Facet arthropathy, disk bulge, and retropulsed osseous fragments results in moderate right and mild left neural foraminal narrowing. No significant central spinal canal stenosis.L1/2: Facet arthropathy, disk bulge and retropulsed osseous fragments results in moderate left neural foraminal narrowing and mild central spinal canal stenosis. Right neural foramina is narrowed by the kyphoplasty cement.L2/3: Facet arthropathy and disk bulge results in moderate right and mild left neural foraminal narrowing. No significant central spinal canal stenosis. L3/4: Facet arthropathy and disk bulge results in moderate bilateral neural foraminal narrowing. Mild central spinal canal stenosis. L4/5: Facet arthropathy and disk bulge results in mild bilateral neural foraminal narrowing and central spinal canal stenosis. L5/S1: Facet arthropathy, ligamentum flavum thickening, and disk bulge results in moderate right neural foraminal narrowing. Moderate left neural foraminal narrowing from degenerative changes as well as tumor extension as detailed above. No significant central spinal canal stenosis. | 1.New moderate compression deformity at L3 with at least 50% height loss.2.New lytic metastatic lesions involving L5 vertebral body and pedicle, left sacral alae, and right iliac wing.3.Multilevel degenerative changes as above.Findings relayed to Dr. Jin Choi Kwang over the phone at approximately 1120 hours |
Generate impression based on findings. | 60-year-old with history of calcifications in the right breast but no breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No dominant mass, suspicious microcalcifications or areas of architectural distortion in either breast. Calcifications in the right breast near the 12 o'clock position do not appear significantly changed.Benign appearing lymph nodes are projected over both axillae. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Reason: Pt with worsening sob and chest pain. r/o pe History: sob, hypoxia, cp PULMONARY ARTERIES: No evidence of pulmonary embolism. The main pulmonary artery is mildly enlarged, suggestive of pulmonary hypertension.LUNGS AND PLEURA: A solid, round non-calcified left upper lobe nodule measures 11 x 11 mm (series 10, image 50), unchanged from the prior exam dated 08/2014. No new suspicious nodules or masses.Stable basilar atelectasis/scarring. Lingular atelectasis appears similar to the prior exam, likely compressive secondary to cardiomegaly. Mild dependent atelectasis.Mildly prominent septal lines, likely reflective of pulmonary edema, decreased from the prior exam.No new focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is enlarged, without pericardial effusion. Severe coronary artery calcification.Scattered small mediastinal and hilar lymph nodes, some calcified.CHEST WALL: Mild degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Pneumobilia, compatible with known choledochojejunostomy.Significant atherosclerotic calcification of the abdominal aorta and its branches. | 1. No evidence of pulmonary embolism. 2. Unchanged 11-mm left upper lobe solid nodule. Recommend continued one year interval followup imaging.3. Mildly prominent septal lines, likely reflective of pulmonary edema, decreased from the prior exam.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Reason: AMS, vascular risk factors, hypoglycemia in ED, GFR 42 Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.Atherosclerotic calcifications are present along the distal internal carotid arteries. There is 40% narrowing of the cavernous portion of the right internal carotid artery associated with atherosclerotic calcifications.There is extracranial origin of the right posterior inferior cerebellar artery.The anterior communicating artery and the posterior communicating arteries are identified and are intact.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. Periventricular and subcortical white matter hypodensities of a moderate degree are present.A small hypodensity is redemonstrated along the peripheral aspect of the right cerebellar hemisphere punctate hypodensities are present along the right basal ganglia.Atherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the extracranial vasculature which is often seen with renal failure and diabetes.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for aneurysm.2.No evidence for cerebral vascular occlusive disease.3.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 4.Lacunar infarcts - age indeterminate- involving the right cerebellar hemisphere and right basal ganglia. |
Generate impression based on findings. | 80 year old female with history of RCC and ? recurrence w/ acute onset dyspnea History: acute onset dyspnea and hypoxia. PULMONARY ARTERIES: No evidence of acute pulmonary embolism. Upper normal main pulmonary artery diameter.LUNGS AND PLEURA: Moderate right pleural effusion and small left pleural effusion with fluid in the fissures. Overlying reticular/airspace opacities in the right lower lobe may represent interstitial lung disease and/or acute infection. Scattered areas of scarring and traction bronchiectasis. Small nodular density within the right anterior upper lobe bronchus was noted on previous CT from 2010. No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: Enlarged heart without significant pericardial effusion or evidence of right heart strain. Severe aortic and coronary calcifications. Scattered borderline mediastinal lymph nodes are again noted; for reference a right pretracheal lymph node measures 10 mm, unchanged (series 6, image 117).CHEST WALL: Diffuse osseous changes consistent with renal osteodystrophy are again noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Nodular left adrenal gland is not well visualized on today's study. No acute process identified in the upper abdomen. Dense aortic calcifications. | 1.No evidence of acute pulmonary embolism.2.Bilateral pleural effusions with overlying air space opacities in the right lower lobe that may represent acute infection or aspiration.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Postoperative changes of left parietal craniotomy with residual amount of blood products in the resection cavity. Bone flap is well positioned. There has been an erval decrease in the gaseous foci within the resection cavity, compatible with evolving postsurgical changes. There is edema or fluid along the subcutaneous tissues overlying the craniotomy measuring up to 7 mm in thickness. There may be a small amount of epidural thickening/fluid subjacent to the craniotomy.No new regions of acute intracranial hemorrhage. No evidence of mass, mass effect, or midline shift. The ventricles and sulci are normal in size. No evidence of osseous erosion or evidence of subgaleal fluid collections. The visualized portions of the paranasal sinuses and mastoid air cells are clear. | 1.Postoperative changes of left parietal extra-axial tumor resection with residual edema and fluid along the subcutaneous tissues adjacent to the craniotomy and perhaps minimal epidural thickening/fluid. 2.The bone flap is well positioned without evidence of erosion. |
Generate impression based on findings. | There is no acute intracranial hemorrhage, mass effect, or midline shift. Mild periventricular hypoattenuation is unchanged. The ventricles, sulci, and cisterns are normal in size and configuration with preserved gray-white differentiation. The calvarium is unremarkable without fracture. The imaged portions of the orbits, paranasal sinuses, and mastoid air cells are unremarkable. | No acute intracranial hemorrhage or mass effect. Mild chronic small vessel ischemic disease. |
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