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Generate impression based on findings. | Reason: r/o mass, stroke, other acute intracranial process History: new onset seizure 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 focus of encephalomalacia is present in the right occipital lobeNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 3.Small focus of encephalomalacia is redemonstrated in the right occipital lobe |
Generate impression based on findings. | Reason: mucoepidermoid of lung; reccurrent disease @ right main stem bronchus/ paramediastium. S/p 4 cycles of adjuvant chemo. Pls c/w previous PET sand CT scan s to evalaute tx response and dx status History: mucoepidermoid tuor of lung CHEST:LUNGS AND PLEURA: Postop change right upper lobectomy. Reference 2-mm nodule in anterior wall of right main stem bronchus (image 36/101) unchanged and could represent either residual disease or postop change. It was by report negative on PET but is too small for reliable evaluation by PET.MEDIASTINUM AND HILA: Residual thymic tissue. 9-mm paramediastinal nodule abutting the right atrial appendage (image 45/149) not significantly changed. This is poorly visualized on prior CT as it was performed without IV contrast it is grossly stable in size in retrospect.CHEST WALL: No significant abnormality noted..ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted..SPLEEN: No significant abnormality noted..ADRENAL GLANDS: No significant abnormality noted..KIDNEYS, URETERS: No significant abnormality noted..PANCREAS: No significant abnormality noted..RETROPERITONEUM, LYMPH NODES: No significant abnormality noted..BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted..BONES, SOFT TISSUES: No significant abnormality noted..OTHER: No significant abnormality noted.. | Stable CT with reference measurements as above. |
Generate impression based on findings. | Reason: c/f new stroke R MCA territory History: LUE weakness, new hypodensity on CT Neck CTA: There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the left vertebral artery. There is approximately 50% stenosis at the proximal right subclavian artery which was also present on the prior exam. It is now associated with some atherosclerotic calcificationThe proximal internal carotid arteries are highly tortuous. There is redemonstration of weblike defects within the midportion of the left internal carotid artery associated with focal dilation to approximately 8 mm. The caliber of the left internal artery distal to this is 5 mm. To a lesser degree there are some weblike defects along the distal right internal carotid arteryAsymmetrically attenuated caliber of the right vertebral artery likely represents dissection, which is new since 2003 and unchanged since February 2012. Additionally, there are multiple consecutive smoothly narrowed foci of high grade (greater than 90%) stenosis within the midportion of the right vertebral artery at the level of C4 -- C6.The thyroid gland lobes are heterogeneous in appearance especially along the posterior aspects but unchanged from the 2/1/2012 study.Multilevel degenerative changes of the cervical spine centered at C4-- C5 with mild narrowing of the spina canal and neural foramina with straightening of the cervical lordosis. This is stable when compared to May 2012 exams.Previously described scattered nonspecific pulmonary micronodules are not appreciated in today's examination.Brain CTA: There is a stable 3 x 2 mm aneurysm in the right pericallosal artery at the origin of the anterior internal frontal artery, unchanged from 2003.There is infundibulum at the origin of the right ophthalmic artery.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 is a small and the posterior communicating arteries are tiny.The right vertebral artery is smaller than the left vertebral artery areCT head:Since the prior exam the patient has developed a new hypodense focus involving gray and white matter in the left middle frontal gyrus extending to the left inferior frontal gyrus measuring 26 x 35 mm axial dimensions. It is associated with adjacent sulcal effacement. It is less conspicuous on the 2/22 exam.There is a focus of encephalomalacia present in left precentral gyrus measuring approximately 1.5 cm in size. Another one is identified in the left postcentral gyrus measuring approximately 27 x 16 mm axial dimensions. A smaller one is located in the right postcentral gyrus measuring 7 mm and one in the right inferior parietal lobule measuring 5mm in size were not present in 2003 but were present in 2008. There is a larger focus of encephalomalacia present along the right occipital lobe which was also present on the prior exams.No evidence of hydrocephalus. Ventricles, cerebral sulci and basal cisterns are normal. There is no evidence of intra-or extra axial fluid collection, midline shift or mass effect. Visualized paranasal sinuses demonstrate minor opacities. The mastoid air cells patent. The orbits are normal. The eyeball lenses are thin. | 1.Findings suggest subacute infarction involving left middle frontal gyrus and to a lesser degree left inferior frontal gyrus. 2.Findings along bilateral internal carotid arteries suggest vasculopathy - possibly fibromuscular dysplasia. Findings suggests pseudoaneurysm formations along the cervical portions of the internal carotid arteries - left worse than right.3.There are high-grade multifocal stenoses along the cervical portion of the right vertebral artery at the C4-C6 vertebral levels suggestive of prior dissection. This is new since 2003 but present 2/2012.4.Stable 3 x 2 mm right pericallosal artery aneurysm at the origin of the right anterior internal frontal artery.5.50% stenosis along the proximal right subclavian artery.6.Multiple foci of encephalomalacia are present in both hemispheres as detailed above. |
Generate impression based on findings. | There is no significant adenopathy by CT size criteria. Index right level 2 a lymph node measures 6 x 6 mm (series 6, image 42), previously measuring 7 x 7 mm (series 2, image 28). An additional index left level IIb lymph node which measures 5 x 5 mm (series 6, image 32), previously measuring 4 x 2 mm (series 2, image 23). Compared to the 11/19/2013 examination, there has been significant interval decrease/resolution of lymphadenopathy.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 are no soft tissue masses. | Significant interval decrease in lymphadenopathy when compared to the remote examination from November 2013. No new or progressive adenopathy by CT size criteria. |
Generate impression based on findings. | 72 years Female with throat pain for 6-7 months and difficulty swallowing. There are mildly enlarged nonspecific left submandibular and submental lymph nodes. There is no discrete mass lesion. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. The osseous structures are unremarkable. The airways are patent. The imaged intracranial structures are unremarkable. The imaged portions of the lungs are clear. | 1. No soft tissue mass or other specific findings to account for the patient's symptoms. 2. Mildly enlarged nonspecific left submandibular and submental lymph nodes which are likely reactive. |
Generate impression based on findings. | 71 year old woman with history of left breast IDC, s/p mastectomy 2012. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Benign-appearing calcifications and asymmetries in the right breast appear stable back to 2010. No new dominant mass, suspicious microcalcifications or areas of architectural distortion in the right breast. Benign appearing lymph nodes are projected over the right axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Left upper quadrant abdominal pain. Intermittent luq pain with shortness of breath. PULMONARY ARTERIES: No evidence of pulmonary embolism. The main pulmonary artery is normal in caliber.LUNGS AND PLEURA: No suspicious pulmonary nodules or masses.Mild basilar and subpleural subsegmental atelectasis/scarring.No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. No visible coronary artery calcification.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, limited visualiztion. | No evidence of pulmonary embolism or other acute abnormality to account for the patient's symptoms.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Reason: 61 yo woman with hx of upper lobe opacities in 2008, please evaluate for interval change History: nodules and shortness of breath LUNGS AND PLEURA: Scattered residual subcentimeter upper lobe opacities (right > left), now more scar like in appearance, though overall significantly decreased in number and distribution. Very mild centrilobular emphysema.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Renal hypodensities are only partially visualized but grossly stable. Cholelithiasis. | Scattered residual subcentimeter bilateral upper lobe opacities, now more scar like in appearance, though overall significantly decreased in number and distribution. These are presumably post inflammatory. Also consider respiratory bronchiolitis, sarcoidosis, or hypersensitivity pneumonitis. Continued follow-up is recommended as they have not completely resolved and it is not possible to completely exclude malignancy |
Generate impression based on findings. | Male 73 years old Reason: Hodgkin's disease History: f/u; compare with 8/14 CT, presented from outside CHEST:LUNGS AND PLEURA: Scattered calcified and noncalcified micronodules, unchanged. Reference left lower lobe micronodule measuring 2 mm (series 6, image 67). No pleural effusions.MEDIASTINUM AND HILA: Small scattered prevascular and paratracheal lymph nodes, unchanged. Circumferential thickening of the mid to distal esophagus, which is similar to prior exam. Mild coronary artery calcifications.CHEST WALL: Status post median sternotomy.ABDOMEN:LIVER, BILIARY TRACT: Mild internal heterogeneity of the gallbladder, which may represent small stones or sludge. The liver is similar in appearance, given differences in technique. Left peribiliary hypoattenuation, of uncertain clinical significance.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Nonspecific nodularity of the left adrenal gland.KIDNEYS, URETERS: Left upper pole renal cyst, unchanged. Additional small subcentimeter hypodense lesions bilaterally which are too small to characterize but likely represent cysts.RETROPERITONEUM, LYMPH NODES: Mild upper abdominal adenopathy. For reference, a peripancreatic lymph node measures 1.7 x 1.2 cm (series 4, image 105), previously 1.8 x 1.3 cm. Atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Left-sided diverticula without evidence of diverticulitis. Likely underdistention of the cecum (series 4, image are 60).BONES, SOFT TISSUES: Degenerative changes of the thoracic spine.PELVIS: MalePROSTATE, SEMINAL VESICLES: Status post radical prostatectomy.BLADDER: No significant abnormality notedLYMPH NODES: Subcentimeter pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of the lumbar spine.OTHER: Nonspecific scrotal calcifications. | Mild upper abdominal adenopathy, improved. Circumferential thickening of the mid to distal esophagus, which is similar to prior exam, correlate clinically for esophagitis. |
Generate impression based on findings. | 60 year-old male with vertigo and nausea. Evaluate VP shunt.VIEWS: Shunt series: Skull AP/lateral (two views), chest AP/lateral (two views), abdomen AP/lateral (two views) 2/22/2015 21:30 Again seen is a ventriculostomy tube with tip adjacent to the midline in the middle cranial fossa connected to the reservoir in the left parietal region. The strata valve is set at performance level of 1.0, unchanged. The tubing travels along the left neck coursing along the chest and enters the peritoneal space in the left upper quadrant with the tip located in the right upper quadrant. No kinking or disconnection is noted.Normal sized heart. No focal pulmonary opacity. Moderate fecal burden with a nonobstructive bowel gas pattern. | No evidence of shunt malfunction. |
Generate impression based on findings. | Evaluate PICCVIEW: Chest AP and abdomen AP 2/23/15 Tracheostomy tube tip at the level of the thoracic inlet. Feeding tube tip in the stomach within the giant omphalocele. Left lower extremity PICC with tip in the left common iliac vein. Cardiothymic silhouette cannot be evaluated. Minimal perihilar atelectasis not significantly changed. The left lung is largely obscured by the omphalocele. Multiple dilated loops within the omphalocele. | Left lower extremity PICC with tip in the left common iliac vein. |
Generate impression based on findings. | Ms. Smith is a 56 year old female with a personal history of left breast lumpectomy in 2009 for IDC/DCIS followed by radiation and hormonal therapy (Femara therapy). Family history of breast cancer in maternal aunt and paternal aunt. No current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the left breast. There are stable postsurgical changes including architectural distortion, increased density, coarse dystrophic calcifications and skin retraction present within the left lumpectomy site. Scattered benign calcifications are present bilaterally. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | Stable postsurgical changes of the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Reason: Evaluate for interval change in nodules History: Former smoker with lung nodules on serial CT scans LUNGS AND PLEURA: Centrilobular emphysema. Sub-solid irregularly shaped nodule in the left upper lobe is stable measuring 10 mm (image 28/102). Groundglass nodule in the right middle lobe with a central subsolid component (image 53/102) is also stable. Scattered calcified and noncalcified micronodules are nonspecific but unchanged. No new nodules or masses identified.MEDIASTINUM AND HILA: Large heterogeneous left thyroid nodule is unchanged. Severe atherosclerotic calcifications of the aorta and its branches. Mild coronary artery calcifications.CHEST WALL: Mild degenerative changes of the spine. Lipoma in right rotator cuff musculature, unchanged.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Subcentimeter hepatic hypodensity is too small to characterize but stable. S/P cholecystectomy. | Left upper lobe and right middle lobe sub-solid and groundglass nodules persist, are unchanged in size and are suspicious for indolent adenocarcinoma. Recommend continued follow-up. |
Generate impression based on findings. | Suspicion of shaken baby syndrome and a subdural hematoma and underwent removal and then replacement of cranioplasty bone in October of 2014. History of brain injury and trauma. Evaluate skull fracture healing. There interval absence of the right parietal bone flap, with a skull defect that measures up to approximately 6 cm. There is fluid subjacent to the scalp flap measuring up to 8 mm in thickness. There is increase in size of the cystic components of the right parietal lobe encephalomalacia, which protrudes slightly through the skull defect. Smaller areas of encephalomalacia in the bilateral occipital lobes are otherwise not significantly changed. There is associated ex vacuo dilation of the right lateral ventricle. There is no evidence of acute intracranial hemorrhage. There is no midline shift. The imaged paranasal sinuses and mastoid air cells are clear. | Interval resorption of the right parietal bone flap with a skull defect that measures up to 6 cm and increase in size of the cystic components of the right parietal lobe encephalomalacia, which is perhaps in proportion to interval head growth, but it protrudes slightly through the skull defect. Smaller areas of encephalomalacia in the bilateral occipital lobes are otherwise not significantly changed. |
Generate impression based on findings. | Left breast cancer. RADIOPHARMACEUTICAL: The left breast was prepared in a sterile manner. A total of 0.463 mCi Tc-99m filtered sulfur colloid was injected in four periareolar injections. A focus of increased activity is noted in the left axilla, representing the sentinel node(s). This region was marked with an indelible marker. | Sentinel node identified in the left axilla. |
Generate impression based on findings. | Reason: h/o upper gum cancer, s/p CRT, compare to previous, measurements pls History: none CHEST:LUNGS AND PLEURA: Basilar dependent edema. Scattered punctate micronodules are unchanged and presumably benign. No new pulmonary nodules.MEDIASTINUM AND HILA: Right chest port tip at RA/SVC junction.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Punctate hepatic hypodensities are too small to characterize but stable and presumably benign.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | Again noted is a 3 cm sized cystic lesion in the superior vermian cistern which follows CSF signal and exerts downward mass effect on the vermis. No diffusion restriction to suggest ischemia. No masses or midline shift. No acute intracranial hemorrhage, extra-axial fluid collections, or subdural hematomas. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. The pituitary gland is normal in size. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. | 1.No acute intracranial abnormality. 2.Cystic lesion in the superior vermian cistern is most likely an arachnoid cyst. |
Generate impression based on findings. | Reason: transplant work up History: heart failure LUNGS AND PLEURA: Very mild emphysema. Scattered punctate micronodules, some of which are calcified, are presumably post inflammatory.MEDIASTINUM AND HILA: Status post CABG. severe coronary calcification. Multi-lead ICD present with some orphaned leads. Battery pack in left chest wall. Relatively saccular thoracoabdominal aortic aneurysm measuring up to 42 mm in AP dimension just above the hiatus. Scattered small subcentimeter lymph nodes.CHEST WALL: Median sternotomy.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Aortic aneurysm as above. | No acute cardiopulmonary normality. |
Generate impression based on findings. | Male; 70 years old. Reason: assess for pneumonia vs. interstitial lung disease vs. chronic aspiration as cause of recurrent respiratory symptoms History: SOB, cough. Diagnostic sensitivity is limited by patient motion.LUNGS AND PLEURA: Small to moderate bilateral pleural effusions, right greater than left. Marked bronchial wall thickening with suggestion of some nodular and tree in bud opacities in the left mid lung and along the minor fissure. Calcified granuloma in the superior aspect of the left lower lobe. 11 mm nodule in the right lower lobe appears to be a focus of atelectasis. No suspicious pulmonary nodules or masses are noted.MEDIASTINUM AND HILA: Normal heart size without significant pericardial effusion. Moderate coronary and aortic calcifications. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: Mild multilevel spinal degenerative disease.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Marked bronchial wall thickening with scattered tree in bud/nodular opacities. Findings are suggestive of bronchitis with possible superimposed aspiration or atypical infection.2.Moderate bilateral pleural effusions, right greater than left. |
Generate impression based on findings. | Reason: CVA History: CVA. Speech disturbance Since the prior exam the patient has developed a new hypodense focus involving gray and white matter in the left middle frontal gyrus extending to the left inferior frontal gyrus measuring 26 x 35 mm axial dimensions. It is associated with adjacent sulcal effacement.There is a focus of encephalomalacia present in left precentral gyrus measuring approximately 1.5 cm in size. Another one is identified in the left postcentral gyrus measuring approximately 27 x 16 mm axial dimensions. A smaller one is located in the right postcentral gyrus measuring 7 mm and one in the right inferior parietal lobule measuring 5mm in size were not present in 2003 but were present in 2008. There is a larger focus of encephalomalacia present along the right occipital lobe which was also present on the prior exams.No evidence of hydrocephalus. Ventricles, cerebral sulci and basal cisterns are normal. There is no evidence of intra-or extra axial fluid collection, midline shift or mass effect. Visualized paranasal sinuses demonstrate minor opacities. The mastoid air cells patent. The orbits are normal. The eyeball lenses are thin. | 1.Findings suggest subacute infarction involving left middle frontal gyrus and to a lesser degree left inferior frontal gyrus. No associated acute intracranial hemorrhage is appreciated.2.Multiple foci of encephalomalacia are present in both hemispheres as detailed above. |
Generate impression based on findings. | Female 28 years old Reason: elbow dislocation f/u History: pain. There is a fracture of the coronoid process minimal volar displacement of the distal fracture fragment, which is unchanged from the prior exam and known to be comminuted based on prior CT. There is surrounding callus formation indicating interval healing. | Healing proximal ulnar fracture as described. |
Generate impression based on findings. | Reason: thyroid cancer with mediastinal and lung nodules History: none CHEST:LUNGS AND PLEURA: Diffuse pulmonary metastases grossly stable in size and number. Reference right upper lobe nodule near the fissure measures 12 x 12-mm (image 39/121), unchanged.Adjacent to the diaphragm, a left lower lobe nodule (image 67/121) measures 14 x 13 mm unchanged. MEDIASTINUM AND HILA: Reference left interlobar lymph node measures 15-mm on image 50/146, unchanged. Reference low left paratracheal region lymph node (image 38/146) measures 13-mm, unchanged. Other nodes, some of which are calcified, are also stable. CHEST WALL: Post traumatic deformities on the left.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: Calcified granulomas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable presumed right renal cyst.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Soft tissue stranding and air anterior abdominal wall presumably secondary to medication injection.OTHER: No significant abnormality noted. | Stable pulmonary metastases and intrathoracic lymphadenopathy. |
Generate impression based on findings. | 71 years, Female, Reason: cirrhosis, s/p RFA forHCC. please evaluate. History: same. ABDOMEN:LUNG BASES: 7-mm nodule along the minor fissure (10/4) has the appearance of an intrapulmonary lymph node.LIVER, BILIARY TRACT:Cirrhotic liver morphology. Portal vein is narrowed but appears patent. The common bile duct is massively enlarged to the ampulla measuring up to 2.4 cm (80 80/46), previously 2.3 cm. Multiple perisplenic collateral vessels are noted.Segment two lesion without enhancement status post RFA measuring 2.1 x 1.8 cm (11/27), previously 2.1 x 1.8 cm.Segment two and segment 5 arterially enhancing lesion identified on the prior MRI are not seen on this study. No new suspicious enhancing lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal cyst is unchanged.RETROPERITONEUM, LYMPH NODES: Mildly enlarged periportal node is stable.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Mild degenerative changes and scoliosis of the spine.OTHER: No significant abnormality noted | 1.Hepatic dome lesion is unchanged in size status post RFA without enhancement.2.Arterially enhancing lesions seen on the prior study are not evident. No new suspicious lesions are present.3.Stable enlargement of the common bile duct |
Generate impression based on findings. | 56 year old woman with history of bilateral partial mastectomy in 2014 for bilateral IDC. Three standard views of both breasts, magnification ML and CC views of both breasts and a left exaggerated CC view were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, changed in distribution secondary to surgery. Post-operative architectural distortion and surgical clips are noted bilaterally. There is no new suspicious dominant mass or microcalcifications in either breast. Bilateral benign calcifications are present. | Post-operative changes but 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. | Female 90 years old Reason: rule out osteomyelitis / foreign body History: R foot necrotic lesion. This is a limited study of the right foot for evaluation of osteomyelitis. The bones appear diffusely demineralized. Evaluation of the midfoot and metatarsal bones is limited due to overlapping structures. There is soft tissue swelling over the dorsal aspect of the foot with underlying lucencies and mottled preventing exclusion of infection. | Limited study of the right foot shows soft tissue swelling with questionable gas overlying the dorsal aspect of the foot, concern for infection and osteomyelitis cannot be excluded without additional imaging. If further imaging evaluation is clinically warranted, an MRI or triphasic bone scan should be considered. Findings verbally relayed to Dr. Lena Derani at 1137 am on 2/23/2015 |
Generate impression based on findings. | 10-year-old female, evaluate for fractureVIEWS: Left ankle, AP, oblique, and lateral (3 views) 2/23/15 9:31 Cast obscures underlying osseous detail. Alignment is near anatomic. The distal fibular fracture is poorly visualized. | Casted ankle fracture in near anatomic alignment. |
Generate impression based on findings. | Ms. Martinez is a 68-year-old female with biopsy proven malignancy within the right breast, 9 o'clock location. She presents today for ultrasound guided seed localization prior to surgery on 1/27/2015 with Dr. Chhablani. On review of the prior studies, there is a 0.8 x 0.5 x 0.8 cm mass at the 9 o'clock position of the right breast which was biopsied and contains a Hydromark clip. PROCEDURE: The procedure, risks including bleeding, mistargeting and infection, and benefits of radioactive seed placement were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The right breast was cleansed with chlorhexidine over the target area. Transducer was sterilely sheathed. Local anesthesia was obtained using 2% lidocaine superficially. Using aseptic technique, continuous ultrasound guidance and an inferior to superior approach, an IsoAid preloaded breast localization needle was placed in the mass and adjacent to the clip. The I-125 seed was then deployed. The skin entry site was closed with a Band-Aid. A bracelet was placed on the right breast wrist labeled with the patient's name, MRN, number of seeds placed, left breast and surgical date (02/27/2015).Post-procedure digital right breast CC and ML views revealed the percutaneously placed seed to be in the expected location in the central aspect of the lesion and adjacent to the clip. No evidence of hematoma or other complication was present. The mammogram was annotated for the surgeon.Post seed placement instructions were given to the patient. Patient tolerated the procedure well and left the breast imaging center in stable condition. Drs. Sheth and Schacht performed the procedure. | Successful radioactive seed localization of the right breast malignancy.BIRADS: 6 - Known cancer.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Male; 59 years old. Reason: h/o laryngeal cancer and CRT, compare to previous, measurements please. CHEST:LUNGS AND PLEURA: Postoperative change is again noted in the right upper lobe. 4 mm micronodule in the right lower lobe is unchanged (series 5, image 69). Lateral pleural-based micronodule (series 5, image 76) and 4 mm micronodule (series 5, image 69), both of which are in the left lower lobe, are also unchanged. No new suspicious pulmonary nodules or masses. No pleural effusions or focal areas of consolidation.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No significant mediastinal or hilar lymphadenopathy. Moderate coronary calcifications. Status post tracheostomy.CHEST WALL: Spinal degenerative changes. No axillary lymphadenopathy.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted. Unchanged splenule.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic right kidney with non-obstructing right renal calculi. Small hypoattenuating lesions with faint calcification in the right kidney are unchanged. Proximal left ureteral stone measuring 5 mm is stable since prior exam (series 3, image 140).PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal or mesenteric lymphadenopathy. Atherosclerotic calcification of the aorta and its major branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology. No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Stable pulmonary micronodules, more likely benign than malignant. However, continued follow-up is recommended. 2.No new suspicious lesions identified in the chest or abdomen. |
Generate impression based on findings. | FractureVIEWS: Pelvis AP Avulsion fracture involving the right anterior inferior iliac spine is again noted and unchanged. Both the femoral heads are seated within the acetabula. | Fracture of the right anterior inferior iliac spine unchanged. |
Generate impression based on findings. | 65 year old woman with history of left breast lumpectomy in 1995. 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. Scar marker over left breast with architectural distortion in the lumpectomy bed. Stable, benign-appearing calcifications are noted bilaterally. No dominant mass or suspicious microcalcifications in either breast. | Post-operative changes of left lumpectomy but 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. | Ms. Gilchrese is a 65 year old female with a personal history of left breast lumpectomy for IDC/DCIS in 04/2014 followed by radiation therapy and endocrine therapy. She has no current breast related complaints. Three standard views of both breasts with three left spot magnification views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the left breast. There are expected postsurgical changes including architectural distortion, increased density, skin thickening and surgical clips present within the left lumpectomy site. Scattered benign calcifications are present bilaterally. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | Expected postsurgical changes of the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 63 years, Male. Reason: NG advanced History: NG advanced, please compare NG tube has been advanced with tip projecting over the gastric antrum. Gallstones in the right upper quadrant. Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | NG tube tip projects over the gastric antrum. |
Generate impression based on findings. | Postop prosthetic assessment Two views of the right hip show components of a total hip arthroplasty device situated near anatomic alignment without radiographic evidence of hardware complication. There has been some maturation of heterotopic ossification between the trochanters and acetabulum.AP view of the pelvis reveals the aforementioned right total hip arthroplasty device. Moderate osteoarthritis affects the left hip. Degenerative arthritic changes also affect the sacroiliac joints and lower lumbar spine. | Right total hip arthroplasty as above. |
Generate impression based on findings. | Metastatic lung cancer with right thigh pain. Evaluate for metastases. Two views of the right hip are provided. I see no focal lesions to suggest metastatic disease to bone. Minimal osteoarthritis affects the hip, essentially within normal limits considering the patient's age. Note is made of an aortobiiliac stent and small surgical clips overlying the pelvis.Two views of the right femur show a 1 cm lobulated calcified focus within the mid to distal femoral diaphysis that I suspect represents a benign enchondroma; it is not the typical appearance of a metastatic focus. I see no lucent lesions. There is atherosclerotic calcification of the femoral artery and its branches. | Small calcified focus in the femoral diaphysis of is of doubtful clinical significance. There is mild osteoarthritis of the hip and additional degenerative and postoperative changes as described above, but I see no focal lesions to suggest metastatic disease to bone. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Reason: mets lung cancer. On Nivolumab. Pls c/w previous study and evauate tx response. History: lung ca CHEST:LUNGS AND PLEURA: Postsurgical changes of a left lower lobectomy and left upper lobe resection, with stable linear and nodular scarring adjacent to the suture line. Mild upper lobe predominant centrilobular emphysema is unchanged.Interval decrease in size and prominence of a small cluster of punctate nodules in the posterior right upper lobe (series 5, image 48), likely postinflammatory in origin. Additional scattered micronodules, some calcified, are unchanged. No new suspicious pulmonary nodules or masses.Mild basilar subsegmental atelectasis/scarring. No new focal air space consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without significant pericardial effusion. Severe coronary artery calcifications.Scattered small lymph nodes, unchanged.A right supraclavicular lymph node measures 7 x 6 mm (series 3, image 5), not significantly changed.A right lower paratracheal lymph node measures 8 x 6 mm (series 3, image 30), unchanged.A subcarinal lymph node measures 8 mm (series 3, image 43), unchanged.CHEST WALL: Degenerative disease of the thoracic spine, with anterior wedging at multiple levels, unchanged.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Scattered subcentimeter hypodense hepatic lesions are unchanged, likely benign.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Stable left adrenal nodule.KIDNEYS, URETERS: Unchanged renal hypodensities, likely benign cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches. IVC filter.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative disease of the lumbar spine.OTHER: No significant abnormality noted. | 1. Decrease in size of a cluster of subcentimeter right upper lobe nodules, likely benign and post-inflammatory in origin.2. Otherwise unchanged exam, without evidence of recurrent or metastatic disease. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is mostly fatty replaced, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | 85 years, Female. Reason: colitis on CT, continues without bowel movement, now not passing flatus, eval free air or obstruction History: abdominal pain Surgical clips, sutures material, and sternotomy wires are unchanged. Dilated loops of small bowel with multiple air fluid levels and a dilated cecum are noted. Residual contrast is noted in the distal colon and diverticula. No pneumoperitoneum. Severe degenerative changes affect the hips bilaterally, right greater than left. | Findings suggestive of at least a partial small bowel obstruction. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. If the patient submits her old mammograms, we can compare them with the current study to establish stability.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Male; 82 years old. Reason: pulmonary aspergillus, please assess cavity History: cough. LUNGS AND PLEURA: Large right apical cavitary lesion with surrounding consolidation and adjacent pleural thickening. While some debris within the cavity has cleared since the prior outside CT from December 2014, the overall appearance of the lesion is not significantly changed since January 2014. Associated collapse of the surrounding right upper lobe is again noted with traction bronchiectasis.Upper lobe predominant subpleural nodularity with associated reticulonodular and tree in bud opacities are not significantly changed since prior CT. No pleural effusions or evidence of acute superimposed infection.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Scattered moderately enlarged mediastinal lymph nodes are likely reactive. Severe coronary calcifications. Aneurysmal dilatation of the ascending and descending aorta.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Atypical renal cysts with rim calcification, not significantly changed. | 1.Large right apical cavitary lesion with surrounding atelectasis and bronchiectasis, which can be seen in mycobacterium avium-intracellulare (MAI) infection. While some debris within the cavity has cleared since the prior outside CT, the overall appearance of the lesion is not significantly changed since January 2014. 2.Stable upper lobe predominant subpleural nodularity and associated reticulonodular/tree in bud opacities, also compatible with chronic MAI infection. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 40 year-old male with right hip pain. Mild osteoarthritis affects the hip. I otherwise see no findings to account for the patient's pain. | Mild osteoarthritis. |
Generate impression based on findings. | Female 50 years old; Reason: abdominal pain ABDOMEN:LUNGS BASES: Trace pericardial effusion.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric renal parenchymal enhancement.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal appendix.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Lower thoracic degenerative disease of spine. Fat and bowel containing umbilical hernia, defect measures 4.5 cm. | 1. Fat and bowel containing umbilical hernia, stable. No bowel obstruction. 2. Unremarkable exam otherwise. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | 65-year-old male with history of multiple myeloma, pre-auto stem cell transplant evaluation. SKULL: I see no definite myelomatous lesionsCERVICAL SPINE: Severe degenerative disk disease affects the lower cervical spine, but I see no lytic lesions. There is loss of the normal cervical lordosis. THORACIC SPINE: There is moderate to severe multilevel degenerative disk disease, but I see no myelomatous lesions. LUMBAR SPINE: There is severe multilevel degenerative disk disease, but I see no myelomatous lesions.RIBS: I see no myelomatous lesions.PELVIS: I see no myelomatous lesions.UPPER EXTREMITY: Two views of the right humerus show a few poorly defined small lucencies in the humeral diaphysis that are nonspecific, but could conceivably represent small myelomatous deposits. Mild osteoarthritis affects the acromioclavicular joint.Two views of the left humerus show a poorly defined lucency in the proximal humeral diaphysis that is nonspecific, but could conceivably represent a myelomatous deposit. Mild osteoarthritis affects the acromioclavicular joint.AP views of the right and left forearms reveal no definite myelomatous lesions. A subchondral lucency with sclerotic margins in the distal right radius likely represents a degenerative cyst or chronic erosion. A small lucency within the left ulnar styloid may likewise represent a cyst or chronic erosion.LOWER EXTREMITY: Two views of the right femur reveal small poorly defined lucencies in the distal femoral metaphysis which I suspect represent degenerative cysts in the femoral trochlea. I see no definite myelomatous lesions.Two views of the left femur reveal no myelomatous lesions.An AP view of the right tibia/fibula and an AP view of the left tibia/fibula reveal no myelomatous lesions. | Although I see no definite myelomatous deposits, small poorly-defined lucencies within the proximal humeral diaphyses could conceivably represent myelomatous deposits or simply a manifestation of mild osteopenia. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 2-year-old male with right foot injuryVIEWS: Right foot, AP and lateral (two views), right tibia and fibula, AP and lateral (2 views views) 2/23/15 10:01 Foot: Periosteal reaction and subtle sclerosis about the proximal aspect of the first metatarsal consistent with a healing nondisplaced fracture. There are questionable nondisplaced healing fractures of the proximal second and third metatarsals. Soft tissue swelling about the dorsum of the foot.Tibia and fibula: The tibia and fibula are intact. Alignment is anatomic. | Healing nondisplaced fracture of the first metatarsal and additional findings as described above. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. There is a new circumscribed asymmetry at inner aspect in the left breast on the CC view.No suspicious microcalcifications or areas of architectural distortion are present. | New circumscribed asymmetry at inner aspect in the left breast on the CC view for which spot compression views and possible ultrasound study are recommended. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: EC - Additional Mammo/Ultrasound Workup Required. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Small masses in the lower outer right breast are stable.No suspicious masses, microcalcifications or areas of architectural distortion are present. A defibrillator generator projects over the left axilla, limiting evaluation of this region. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | 53 year old woman with history of left breast cancer on neoadjuvant chemotherapy. Three standard views of the left 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. Biopsy clips are noted in the left axilla and in the left upper outer quadrant. Pleomorphic and linear calcifications are seen in the left upper outer breast immediately inferior to the biopsy clips in a linear distribution. There is decreased density of the breast asymmetry in the area of calcfications and no new dominant mass or areas of architectural distortion in the left breast. Lymph nodes in the left axilla have decreased in size significantly compared to the last exam. | Decrease in left axillary lymph nodes and asymmetry in the left breast in the area of calcifications compatible with treatment response. Followup with surgery scheduled. Results and recommendations discussed with patient. BIRADS: 6 - Known cancer.RECOMMENDATION: B - Surgical Consultation. |
Generate impression based on findings. | Fracture.VIEWS: Left great toe AP/lateral (two views) 02/23/15 Salter Harris II fracture of distal phalanx is unchanged in appearance. The physis remains widened. A metaphyseal fragment is seen anteriorly. No bone destruction is present. | Unchanged Salter-Harris fracture distal phalanx of great toe. |
Generate impression based on findings. | Six weeks postop status post right total hip arthroplasty Three views of the right hip are provided. Components of a total hip arthroplasty device are situated in near anatomic alignment appearing similar to the prior study. A small amount of heterotopic mineralization is noted between the greater trochanter and acetabulum.Three views of the pelvis revealed the aforementioned right total hip arthroplasty. Severe osteoarthritis affects the left hip. The remainder of the pelvis is unremarkable. | Total hip arthroplasty as above. |
Generate impression based on findings. | 34 year old female with history of metastatic breast cancer, evaluate for response to treatment. CHEST:LUNGS AND PLEURA: Scattered pulmonary micronodules decreased in number from prior. No new suspicious nodules or masses. Post radiation changes are present in the upper lobe of the left lung.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.CHEST WALL: Scattered sclerotic osseous foci within the sternum, right proximal humerus, and bilateral ribs compatible with metastases. Postsurgical changes in the breasts.ABDOMEN:LIVER, BILIARY TRACT: Innumerable hepatic lesions compatible with metastatic disease grossly unchanged in size but with decreased enhancement compared to prior. There are scattered areas of right hepatic lobe ductal dilatation due to mass effect from the lesions. The reference right hepatic lobe lesion measures 3.2 x 3.4 cm (series 4, image 107), previously 3.4 x 3.5 cm. SPLEEN: Small low-attenuation lesions in the spleen suspicious for metastases, similar in size but which show decreased enhancement compared to prior.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered sclerotic osseous foci within the spine and pelvis compatible with metastases, appearing similar to prior.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Uterus is absent or atrophic.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Scattered sclerotic osseous foci within the spine and pelvis compatible with metastases, appearing similar to prior.OTHER: Small amount of free fluid in the pelvis which may be physiologic. | 1.Multiple hepatic metastases, grossly unchanged in size but with decreased enhancement compared to prior.2.Splenic lesions suspicious for metastases, grossly unchanged in size but with decreased enhancement compared to prior.3.Multiple subcentimeter pulmonary micronodules suspicious for metastases, decreased in number.4.Widespread osseous metastases appearing grossly similar to prior, though nuclear medicine bone scan more sensitive. |
Generate impression based on findings. | 15-year-old male with history of fractureVIEWS: Right wrist, AP, oblique, and lateral (3 views views) 2/23/15 10:19 Splint obscures underlying osseous detail. Again visualized is a transverse fracture through the fifth metacarpal with mild volar angulation of the distal fracture fragment. | 5th metacarpal fracture as described above. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. Tomosynthesis images are also obtained. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | Knee pain Four views of the left knee are provided. Tricompartmental osteophytes indicate mild osteoarthritis. Mild osteoarthritis also affects the right knee as seen on the frontal views. | Mild osteoarthritis. |
Generate impression based on findings. | Wrist drop. Question joint subluxation.VIEWS: Right wrist PA/lateral/oblique (3 views) 02/23/15 A splint obscures detail. The bones are normal in appearance. No fracture is identified. | Normal examination. |
Generate impression based on findings. | Pain Four views of the left knee are provided. There is deformity of the distal femoral diaphysis likely representing an old healed fracture, incompletely imaged on this study. There is moderate narrowing of the medial tibiofemoral compartment and tricompartmental osteophytes indicating moderate osteoarthritis. There also appears to be a small to moderate-sized joint effusion.Mild osteoarthritis affects the right knee as seen on the frontal view. | Osteoarthritis and other findings as above. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is heterogeneously dense. There is an asymmetry at lateral aspect in the left breast on the CC view. No suspicious microcalcifications or areas of architectural distortion are present. | Asymmetry at lateral aspect in the left breast on the CC view. Comparison to old mammograms is recommended. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: O - Old Study For Comparison. |
Generate impression based on findings. | Male 86 years old Reason: dysphagia rule out obstruction History: as above Double contrast evaluation of the esophagus again demonstrated a large right posterolateral diverticulum which filled with contrast during swallowing. The appearance is consistent with a large Zenker's diverticulum. This measures approximately 3.9 by 2.1 cm (cine series 14; 15). No hiatal hernia was identified. Fluoroscopic examination of esophageal motility revealed hold up of passage of oral contrast in the distal esophagus with proximal escape and tertiary contractions consistent with mild motility abnormality.No gastroesophageal reflux was identified. | 1. Large right posterolateral Zenker's diverticulum, unchanged compared to prior study. 2. Mild motility abnormality.Fluoroscopy time: Four minutes and 37 seconds. |
Generate impression based on findings. | 48 year old male with history of metastatic melanoma, evaluate response to treatment. CHEST:LUNGS AND PLEURA: No suspicious nodules or masses. Mild coronary artery calcifications.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.CHEST WALL: Left axillary soft tissue thickening measures 1.0 x 1.5 cm (series 7, image 37) previously 1.0 x 1.5 cm, nonspecific but may reflect surgical scarring. Left axillary surgical clips are noted. Postsurgical changes along the left back appearing similar to prior.ABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis which somewhat limits evaluation for lesions.Reference segment 8 lesion with adjacent surrounding parenchymal enhancement measures 1.0 x 2.0 cm (series 7, image 100) previously 1.0 x 2.0 cm. Previously seen segment 4 and segment 6 lesions are not well visualized. No new lesions are identified.Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Reference portacaval lymph node measures 1.0 x 2.1 cm (series 6, image 46) previously 1.0 x 2.1 m. No additional pathologically enlarged lymph nodes identified.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Perianal soft tissue thickening and foci of gas seen on the prior exam are not included in the field of view.OTHER: No significant abnormality noted | 1.Stable size of hepatic metastasis. No new metastatic lesions identified. 2.Stable left axillary soft tissue thickening which may represent surgical scarring.3.Previously seen perianal abscess not included in the field-of-view. |
Generate impression based on findings. | Male 75 years old Reason: Any evidence of obstruction History: Pt has feeling food gets stuck Double contrast evaluation of the esophagus revealed no mucosal abnormalities. There was an abnormal indentation on the posterior aspect of the pharynx with abnormal outpouching of the right posterolateral esophagus immediately inferior to this. The location is atypical for a cricopharyngeal bar and this appearance may be secondary to discoordination of swallow secondary to spasm of the inferior pharyngeal constrictor muscle. Note is made of a small left pharyngocele. Fluoroscopic examination of esophageal motility revealed normal motility. No gastroesophageal reflux was identified. | Discoordination of swallow, felt to be secondary to spasm of the inferior pharyngeal constrictor muscle.Fluoroscopy time: Five minutes and 9 seconds. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD, version 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Scattered benign calcifications have progressed in left breast in benign fashion. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Prominent fluid is noted bilaterally overlying the frontal lobes which appears to cause mild underlying gyral flattening, however without significant mass effect and no resulting herniations. These measure up to 10 mm bilaterally. Similar appearing fluid collections are also seen bilaterally overlying the cerebellar hemispheres. These are CSF intensity on all sequences, demonstrate unencumbered bridging veins, and have no associated susceptibility abnormality.The ventricles are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for acute intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. | Prominent fluid is noted bilaterally overlying the frontal lobes which appears to cause mild underlying gyral flattening, however without significant mass effect and no resulting herniations. These measure up to 10 mm bilaterally. Similar appearing fluid collections are also seen bilaterally overlying the cerebellar hemispheres. These are CSF intensity on all sequences, demonstrate unencumbered bridging veins, and have no associated susceptibility abnormality. The differential diagnosis would hygromas versus chronic subdural hematomas. The latter is felt to be less likely due to a lack of hemosiderin staining on susceptibility imaging. |
Generate impression based on findings. | Female 51 years old Reason: eval RT wrist History: pain. A comminuted distal radial fracture with overlying fixation otherwise appears intact, without change in alignment. There is a mild increase of visibility of the fracture planes compatible with subacute healing. Mild lunate subluxation persists. | Healing distal radial fracture as described above. |
Generate impression based on findings. | Female; 71 years old. Reason: r/o PE, oxygen desat History: oxy desat, post operative. PULMONARY ARTERIES: No evidence of acute pulmonary embolism. Normal main pulmonary trunk diameter.LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. Small right pleural effusion with overlying consolidation which may represent aspiration and/or mucus plugging. Trace left basilar scarring is also noted.MEDIASTINUM AND HILA: Upper normal heart size without pericardial effusion. Severe coronary artery and aortic calcifications. No mediastinal or hilar lymphadenopathy.CHEST WALL: Mild spinal degenerative changes.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.No evidence of acute pulmonary embolism.2.Small right pleural effusion with overlying consolidation, possibly secondary to aspiration or mucus plugging.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 71 years, Female, Reason: PNET History: active surveillance. CHEST:LUNGS AND PLEURA: No focal consolidation or pleural effusion. Scattered calcified and noncalcified micronodules are nonspecific. No suspicious nodules or masses.MEDIASTINUM AND HILA: Enlarged heterogeneous thyroid is unchanged. Atherosclerotic calcifications of the aorta and its branches. Moderate coronary artery calcifications.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: Hypodense lesion within the pancreatic body is unchanged measuring 1.6 x 1.3 cm (3/98), previously 1.6 x 1.4 cm.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral perinephric stranding is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: Fibroid uterus.BLADDER: No significant abnormality noted.LYMPH NODES: Reference left inguinal node is stable measuring 1.0 x 0.5 cm (3/171), previously 1.1 x 0.8 cm. No new pelvic lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Moderate to severe degenerative changes of the lower lumbar spine and right sacroiliitis are unchanged.OTHER: No significant abnormality noted. | Stable exam. |
Generate impression based on findings. | 10-year-old male, assess fractureVIEWS: Right humerus, AP and lateral (two views) 2/23/15 10:32 Deformity and extensive callus formation about the proximal humeral metadiaphysis consistent with healing fracture with mild medial angulation of the distal fragment. | Healing proximal humerus fracture. |
Generate impression based on findings. | There has been evolution of immediate postoperative findings related to right MCA aneurysm clipping and right pterional craniotomy. Pneumocephalus, right frontal extra-axial fluid collection have resolved with improvement in mass effect with leftward midline shift of 5 mm, previously 7 mm. Streak artifact related to the aneurysm clip and coil material in the basilar artery limits evaluation. There is redemonstration of right frontal lobe low attenuation probably representing postsurgical change. There is no evidence of intracranial hemorrhage, mass, or cerebral edema. The ventricles and basal cisterns are normal in size and configuration. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | 1.No acute intracranial hemorrhage. 2.Evolution of immediate postoperative findings with decreased mass effect and midline shift. 3.Right frontal lobe area of low-attenuation redemonstrated, probably representing postsurgical change. |
Generate impression based on findings. | Female 47 years old Reason: hx non-erosive RA, evaluate for interval change History: hx non-erosive RA, evaluate for interval change Right hand: No erosions or other radiographic evidence specific for inflammatory arthritis are present. Minimal degenerative changes are otherwise observed. The left hand was not imaged secondary to the patient refusing given discomfort and relayed understanding that different exams were to be ordered/performed.Left foot: Minimal degenerative changes affecting the first metatarsophalangeal joint are minimally progressed from the prior exam. No erosions or other radiographic evidence specific for inflammatory arthritis are present.Right foot: Minimal degenerative changes affecting the first metatarsophalangeal joint are minimally progressed from the prior exam. No erosions or other radiographic evidence specific for inflammatory arthritis are present. | Mild degenerative arthritic changes affecting the first metatarsophalangeal joints bilaterally are minimally progressed from the prior exam. Otherwise, no specific radiographic evidence of inflammatory arthritis is present. Please note, patient refused full hand series, so symmetry cannot be appropriately evaluated. |
Generate impression based on findings. | Ms. Johnson is a 47 year old female with a personal history of right breast mastectomy in March 2014 for DCIS followed by hormonal therapy and implant based reconstruction on the left breast. She has no current breast related complaints. Three implant-displaced views and two full field views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography, unchanged in pattern and distribution. A silicone implant is intact. Scattered benign punctate calcifications are seen in the left breast. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the left breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. In 11/2013, a 6 month MRI was recommended to confirm stability of findings noted in the left breast. MRI should be obtained, especially given her extreme breast density and history of breast cancer at a young age. All results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Female 57 years old Reason: Large B Cell NHL History: s/p 3 cycles of chemotherapy CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Small amount of fluid in the prevascular space, which is slightly increased since exam from 12/3/2014. Heart size is normal without pericardial effusion. Left chest wall port with tip at the confluence of the SVC and innominate vein.CHEST WALL: Left chest wall port.ABDOMEN:LIVER, BILIARY TRACT: Hypoattenuating lesion in the right hepatic lobe has decreased in size now measuring 0.9 x 5.5 cm (series 3, image 85), previously 1.7 x 6.2 cm.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Slight interval decrease in size of exophytic infiltrative right renal mass, now measuring approximately 3.9 x 7.2 cm (series 3, image 117), previously 5.0 x 7.2 cm. The mass infiltrates the right psoas and paraspinal muscles, right hemidiaphragm and right abdominal wall and encases the proximal right ureter. Mild right hydronephrosis.RETROPERITONEUM, LYMPH NODES: Slight interval decrease in the conglomerate aortocaval nodes now measuring 2.1 x 2.9 cm (series 3, image 114), previously 2.2 x 2.3 cm. BOWEL, MESENTERY: Interval resolution of previously seen terminal ileitis.BONES, SOFT TISSUES: Redemonstrated are what appear to be old fractures of the transverse processes of the right L1, L2, and L3 vertebral bodies, previously described right renal/perirenal masslesion extends to this region. Additional degenerative changes of the thoracic spine are seen.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative change of the lumbar spine with leftward curvature.OTHER: The mass appears to extend to the neural foramina of the lower thoracic and upper lumbar spine, better evaluated on prior MR. | Stable to mildly decreased size of the right renal mass and associated adenopathy as described. |
Generate impression based on findings. | Reason: 76 yo man with hx of sarcoid found to have nodules on prior CT scan. Please eval interval change History: cough LUNGS AND PLEURA: UIP pattern with traction bronchiectasis, subpleural honeycombing and reticulation, stable in severity and distribution. Reference left upper lobe nodule is stable to marginally decreased now measuring 13 mm on image 46/117.Second reference subpleural nodule on the right is stable at 9 x 5 mm on image 62/117. Mild air trapping at the lung bases consistent with small airways disease.MEDIASTINUM AND HILA: Moderate bilateral mediastinal lymphadenopathy not significantly changed.Mild enlargement of the main pulmonary artery suspicious for pulmonary hypertension. Severe coronary artery calcifications.Mild cardiomegaly and calcification involving the aortic valve. CHEST WALL: Multilevel degenerative changes of the spine with vertebral body height loss.UPPER ABDOMEN: Absence of IV and enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Stable pulmonary fibrosis and nonspecific small pulmonary nodules. The nodules are most likely inflammatory, though continued follow up is recommended. |
Generate impression based on findings. | There is a small right parafalcine focus of hyperdensity located in the same location as that described on previous MRI as a small hemorrhagic focus, which is overall unchanged in size and morphology given differences in technique.Redemonstrated are multiple foci of encephalomalacia in the right hemisphere compatible prior vascular insults are stable compared to the previous exam. The ventricles are unchanged in appearance. There is no mass effect or midline shift. There are no extraaxial fluid collections or subdural hematomas. Mucosal thickening is present within frontal sinuses. The remaining paranasal sinuses and mastoid air cells are clear. | There is a small right parafalcine focus of hyperdensity located in the same location as that described on previous MRI as a small hemorrhagic focus, which is overall unchanged in size and morphology given differences in technique. The differential diagnosis would include a small subdural hematoma. However, on occasion, falcine deposits can ossify rather than merely calcify resulting in T1 hyperintense signal. For this reason, the differential diagnosis includes ossification of the falx. If the hypodense CT imaging appearance fails to become hypodense of evolving blood products overtime, then the ossification entity would be favored. |
Generate impression based on findings. | Female 59 years old; Reason: Esophageal cancer History: evaluate, compare to previous ABDOMEN:LUNGS BASES: Left basilar pleural bleb formation. Stable trace left pleural effusion.LIVER, BILIARY TRACT: Status post cholecystectomy. Unchanged mild prominence of common bile duct, measuring up to 7 mm.SPLEEN: No significant abnormality noted.PANCREAS: Severe fatty replacement of pancreatic head and uncinate process, unchanged in appearance.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Mild interval decrease in size of reference preaortic lymph node, measuring 1.2 x 0.8 cm on image 51 series 4, previously measured 1.5 x 1.1 cm.BOWEL, MESENTERY: Esophageal stent present in visualized mid to distal esophagus. Debris seen opacifying stent in distalmost aspect of stent, air seen upstream. Please note that patency of esophageal stent cannot be adequately assessed on the basis of this exam. Circumferentially thickwalled distal esophagus, without significant change from prior study. Adjacent lymph nodes in posterior mediastinum seen. Index right-sided paraesophageal lymph node without significant change accounting for differences in technique, measuring 1.3 x 0.7 cm, image 31 series 4, previously measured 1.1 x 0.7 cm. Percutaneous gastrostomy tube located in the proximal body. Moderate amount of pneumoperitoneum, centered in region of hepatic flexure and extending to inferior pole of liver. Bowel not well opacified by enteric contrast at this level but segmental thickwalled appearance suggested. PELVIS:UTERUS, ADNEXA: Atrophic or surgically absent uterus, small vaginal air, nonspecific.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted. | New moderate pneumoperitoneum, given the proximity of air to hepatic flexure, appearance worrisome for colonic perforation, may be treatment related and correlation with patient's clinical history recommended. Esophageal wall thickening, compatible with patient's known history of esophageal cancer, without significant change. Esophageal stent and percutaneous gastrostomy tube in place, please note that patency of esophageal stent cannot be adequately assessed on the basis of this exam. Stable to mild interval decrease in size of reference lymph nodes as above.Findings discussed with ordering physician Dr. Villaflor at 11:42 a.m on 2/23/15. |
Generate impression based on findings. | 67 year old female with history of squamous cell esophageal cancer, compare to previous. CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary and nodules/masses are again seen, not significantly changed. Reference measurements are provided as follows:Cavitary left upper lobe nodule (series 4, image 47) measures 1.3 x 1.6 cm, previously 1.3 x 1.6 cm. Cavitary left lower lobe nodule (series 4, image 60) measures 1.0 x 1.9 cm, previously 1.0 x 1.9 cm.Solid right middle lobe mass (series 4, image 62) measures 1.5 x 2.7 cm, previously 1.5 x 2.7 cm.No new nodules or masses are seen. Left apical scarring unchanged. No pleural disease.MEDIASTINUM AND HILA: Right chest port with catheter tip in the superior vena cava, unchanged. Small, normal-sized mediastinal lymph nodes similar to prior. Severe coronary artery calcifications. Diffuse mid to distal esophageal wall thickening similar to prior.CHEST WALL: ABDOMEN: Lytic lesion in the left fifth rib is unchanged (series 3, image 38). Left sixth rib proximal healed rib fracture is unchanged. No other osseous lesions are seen.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Lobular uterus suggesting fibroids, similar or prior. BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Stable mild thickening of the mid/distal esophagus. 2.Stable pulmonary metastases. 3.Stable appearance of lytic left fifth rib lesion. |
Generate impression based on findings. | BPDVIEW: Chest AP 2/23/15 Endotracheal tube and NG tube have been removed in the interval. Cardiothymic silhouette normal. Patchy atelectasis in the right lower lobe and left lower lobe in a background of chronic lung disease. No pleural effusion or pneumothorax. | Bilateral patchy atelectasis in a background of chronic lung disease. |
Generate impression based on findings. | Reason: History of metastatic breast cancer on treatment. Compare to prior imaging, evaluate for response \T\ extent of disease. History: History of metastatic breast cancer on treatment. Compare to prior imaging, evaluate for response \T\ extent of disease. CHEST:LUNGS AND PLEURA: Stable 5-mm right lower lobe pulmonary nodule (image 74 series 4). The small peri-fissural nodule on the left is also unchanged (image 46 series 4). No new nodules. Mild centrilobular emphysemaMEDIASTINUM AND HILA: No lymphadenopathy.Small hiatal herniaCHEST WALL: Interval decrease in reference left axillary lymph node currently measuring 20 x 15 mm on image 24/150 (24 x 22 mm on prior). Left breast mass is stable unchanged measuring 27 x 14 mm on image 52/150.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Interval decrease in left axillary node. Other findings stable. |
Generate impression based on findings. | Reason: metastatic sarcoma. History: sarcoma LUNGS AND PLEURA: Demonstration of multiple bilateral pulmonary nodules of varying sizes demonstrating mild progressive interval increase in size over the last two exams.Reference right upper lobe nodule (image 40 series 6) now measures 15 mm x 16 mm . This lesion measured 12 mm x 12 mm on the exam dated 7/12/14 and 14 mm x 14 mm on the exam dated 10/18/14.Reference right middle lobe nodule (image 49 series 6) now measures 20 mm x 19 mm, previously measuring 18 mm x 14 mm on the exam dated 10/18/14.Left lower lobe nodule (image 64 series 6) now measures 3.8 cm x 3.5 cm previously measuring 3.5 cm x 3.3 cm on the most recent exam.No new pulmonary nodules can be identified.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Minimal coronary artery calcifications.CHEST WALL: Right chest Port-A-Cath with its tip in the SVC.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Multiple bilateral pulmonary nodules/masses demonstrating mild interval progression in size of these lesions over the last several exams. No new sites of disease identified. |
Generate impression based on findings. | Reason: surviellance imaging History: nasopharynx cancer s/p XRT CHEST:LUNGS AND PLEURA: Mild to moderate apical predominant centrilobular emphysema. No suspicious pulmonary nodules or masses.Mild dependent atelectasis. No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. Mild coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: Status post right axillary lymph node dissection.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Stable subcentimeter hepatic hypodensities, likely benign cysts.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Bilateral renal hypodensities, stable, likely benign cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative disease of the lumbar spine.OTHER: No significant abnormality noted. | No evidence of metastatic disease. |
Generate impression based on findings. | 2 months old, premature birth, 30 weeks, severe micrognathia and partial soft palate cleft. The morphology and attenuation characteristics of the brain are compatible with stated gestational age. No mass effect, edema or loss of gray-white distinction is suspected. No intracranial hemorrhage or abnormal extra-axial fluid collections are detected. The ventricles are normal in size and morphology.The bones of the calvarium are intact. The major cranial sutures are patent and normal for age. A cleft is present involving the posterior aspect of the bony palate. The mandible is severely hypoplastic resulting in at least 12 mm of underbite relative to the maxilla. The nasopharyngeal and oropharyngeal airway is nearly completely effaced with only a few small pockets of air seen. For reference purposes, an airway volume calculation was made yielding at most 18 cubic mm (0.018 cc). | 1. Severe micrognathia with near complete airway effacement.2. Cleft palate. |
Generate impression based on findings. | Male 65 years old; Reason: prostate cancer History: prostate cancer and please compare with previous CT scan CHEST:LUNGS AND PLEURA: Reticular opacities, likely atelectasis or scarring.MEDIASTINUM AND HILA: Coronary artery calcifications. Status post right thyroidectomy. Questionable tiny hiatal hernia.CHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Couple stable, less than 5-mm hypodensities in liver, likely cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral parapelvic cysts.RETROPERITONEUM, LYMPH NODES: Mild calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post prostatectomyBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Bilateral fat containing inguinal hernias.OTHER: No significant abnormality noted | 1.No evidence of metastatic disease. |
Generate impression based on findings. | Reason: lung cancer, resected T2aN0, lobectomy, now prior to chemo History: dyspnea CHEST:LUNGS AND PLEURA: Postop right upper lobectomy. There is small right pleural effusion with mild right basilar scarring and atelectasis. Scattered punctate micronodules, some of which are calcified, are unchanged. Emphysema. Scattered areas of nonspecific interstitial opacity along the periphery the left upper lobe, unchanged.MEDIASTINUM AND HILA: Scattered small mediastinal nodes are unchanged. Postop change from the resection of a few nodes on the right. Borderline right hilar lymph node image 47/153 not significantly changed. Severe coronary calcification. Small thyroid nodules unchanged.CHEST WALL: Degenerative change involving the spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Calcified granulomas.SPLEEN: Calcified granulomas.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable renal hypodensities, presumed cysts.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the aorta and its branches appear scattered small nodes are unchanged.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Right iliac wing (coronal image 45/127) stable. This was negative on PET. Severe multilevel degenerative disk disease, unchanged.OTHER: No significant abnormality noted. | Post op changes from right upper lobectomy with a small right pleural effusion. No definitive measurable disease though there are borderline lymph nodes which should be followed to confirm that they are reactive rather than neoplastic. |
Generate impression based on findings. | 61 year old woman with history of right breast lumpectomy in 2003. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. There are post-operative findings of right breast lumpectomy with architectural distortion and coarse, dystrophic calcifications of fat necrosis. Other benign calcifications are also noted. No suspicious dominant mass, microcalcifications, or areas of architectural distortion are seen in either breast. Benign appearing lymph nodes are projected over the left axilla. | Post-operative changes but 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: metastatic breast ca History: metastatic breast ca CHEST:LUNGS AND PLEURA: Right lower lobe scattered tree-in-bud opacities and scarring, likely related to aspiration. Two new micronodules, including a 4-mm nodule in the right lower lobe (series 4, image 118) were not clearly seen on the prior exam, and may relate to ongoing inflammatory process. Additional scattered benign-appearing micronodules are stable. No suspicious pulmonary masses.No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. No visible coronary artery calcification.No mediastinal or hilar lymphadenopathy.Small hiatal hernia.CHEST WALL: Degenerative disease of the thoracic spine. No focal osseous lesion seen.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: A hypodense lesion in the hepatic dome measures 4.0 x 3.7 cm (series 3, image 63), previously 3 x 2.5 cm, suspicious for metastasis. No new hepatic lesions are identified.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. Increase in size of a hypodense lesion in the hepatic dome, suspicious for metastasis.2. New small micronodules in the right lower lobe, in the setting of local scattered tree-in-bud opacities and scarring, may be related to inflammatory process including aspiration. Metastasis is not excluded. Recommend continued followup imaging. |
Generate impression based on findings. | Ms. Nelson is a 42 year old female recalled from screening mammogram for an asymmetry in the left breast. She has no current breast related complaints. An ML view, CC view and four spot compression views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. The previously identified focal asymmetry in the medial left breast disperses into normal breast parenchyma on spot compression views. Patchy nodular tissue is stable when compared to prior exams. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the left breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Reason: patient with SAH , follow up procedure History: SAH, negative angio on admission Right subclavian artery: There is no evidence for arteriovenous fistula. No evidence for vertebral dissection.Right ascending cervical artery: No evidence for arteriovenous fistula. Right vertebral artery: There is opacification of the basilar artery and the posterior cerebral arteries. The anterior spinal artery supply has origin from this vessel. The posterior meningeal artery originates from this vessel. Since the prior exam the patient has developed smooth narrowing of the intracranial RVA. There is no angiographic evidence for aneurysm, AVF, AVM or vasculitis.Left subclavian artery: There is no evidence for arteriovenous fistula. There is no evidence for vertebral dissection.Left ascending cervical artery: No evidence for arteriovenous fistula. Left vertebral artery: There is opacification of the basilar artery and both posterior cerebral arteries. There is no angiographic evidence for aneurysm, AVF, AVM or vasculitis. Compared to the prior exam the LVA is narrower in caliber on the current exam.Right common carotid artery: There is no stenosis at the carotid bifurcation on the basis of NASCET criteria. There is no evidence for carotid dissection.Right internal carotid artery: There is opacification of the right anterior and middle cerebral arteries. Venous and parenchymal phases were within normal limits. There is no angiographic evidence for vasculitis.Right external carotid artery: There is no evidence for arteriovenous fistula. There is no angiographic evidence for vasculitis.Right occipital artery: No evidence for aneurysm, AVM or AV fistula. Left common carotid artery: There is no evidence for carotid stenosis on the basis of NASCET criteria. There is no evidence for carotid dissection.Left internal carotid artery: There is opacification of the left anterior and middle cerebral arteries. Venous and parenchymal phases were within normal limits. There is no evidence for aneurysm, AVM or AV fistula. There is no angiographic evidence for vasculitis.Left external carotid artery: There is no evidence for arteriovenous fistula. There is no evidence for AVM or AVF. There is no angiographic evidence for vasculitis.Left occipital artery: No evidence for aneurysm, AVM or AV fistula. Right common iliac artery: There is no contraindications for the deployment of a closure device. | 1.No evidence for cerebral aneurysm, AVM, arteriovenous fistula, carotid or vertebral dissection or vasculitis.2.Mild narrowing of the proximal intracranial vertebral arteries and right PCOMA are likely related to vasospasm. |
Generate impression based on findings. | Bilateral knee pain Severe osteoarthritis affects both knees, right greater than left, with tricompartmental joint space narrowing and osteophytes. Possible subcentimeter loose body in the suprapatellar right knee joint. | Severe osteoarthritis. |
Generate impression based on findings. | Medial knee pain Near severe osteoarthritis affects the left knee with joint space narrowing and osteophyte formation. A moderate-sized left knee joint effusion is evident. There is approximately 8 degrees of genu varus. Moderate osteoarthritis affects the right knee, left hip, and left ankle. | Osteoarthritis, as above. |
Generate impression based on findings. | Right total hip arthroplasty Right total hip arthroplasty device situated in near-anatomic alignment. Subtle thin lucency is noted about the acetabular component, however, the acetabular component is not changed in position or orientation compared to prior.Moderate osteoporosis affects the visualized lower lumbar spine. Mild osteoporosis affects the sacroiliac joints. Moderate osteoarthritis affects the left hip.Moderate osteoarthritis affects the right knee. | Right hip arthroplasty, as above. Osteoarthritic changes, as above. |
Generate impression based on findings. | 4-month-old male with NJ tube. Evaluate placement.VIEW: Abdomen AP (one view) 2/23/2015 11:32 Feeding tube tip in the left upper quadrant likely in the stomach. Disorganized nonobstructive bowel gas pattern. | Feeding tube tip in the left upper quadrant likely stomach. |
Generate impression based on findings. | 56 year old woman with history of right breast enhancing lesion on MR. Patient gives history of clear discharge from the right breast. A targeted right ultrasound was performed for the area of concern seen on recent MR. There is a dilated duct at the 6:00 position immediately behind the right nipple. Within this dilated duct and extending peripherally, there is an isoechoic filling defect which measures 19 mm in length and 5 x 4 mm in cross-section with a minimal amount of internal vascularity. No additional solid or cystic mass identified. | Intraductal soft tissue mass in the right breast which likely represents a papilloma. Further characterization with possible ultrasound guided biopsy is recommended in addition to consultation with surgery. Results and recommendation discussed with patient.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: B - Surgical Consultation. |
Generate impression based on findings. | Reason: lung cancer now wiht cough s/p chemorads ck response History: cough and lethargy CHEST:LUNGS AND PLEURA: Left upper lobe mass stable to marginally decreased now measuring 46 x 40 mm on image 38/160 (43 x 47 mm previously)Interval increase in adjacent opacities and pleural thickening consistent with radiation pneumonitis.No new suspicious pulmonary nodules or masses.Upper lobe predominant centrilobular emphysema.Mild tree in bud opacities predominantly in the upper lobes suggestive of bronchiolitis not significantly changed.MEDIASTINUM AND HILA: No significant mediastinal lymphadenopathy. Moderate coronary artery calcifications are present. Bilateral thyroid nodules unchanged. Small pericardial thickening or effusion.CHEST WALL: No significant axillary lymphadenopathy.ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Status post splenectomy.ADRENAL GLANDS: No significant abnormality.KIDNEYS, URETERS: Small renal cysts appear unchanged.PANCREAS: Post op change involving pancreas.RETROPERITONEUM, LYMPH NODES: Previously referenced left upper quadrant mesentery nodule (series 3 image 116) measures 10 mm in short axis and is not significant changed.BOWEL, MESENTERY: Absence of enteric contrast material markedly limits sensitivity for GI pathology.Small ventral hernia containing bowel with no evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Left upper lobe mass stable to marginally decreased.Interval increase in adjacent opacities and pleural thickening suggestive of radiation pneumonitis though continued follow up is recommended. |
Generate impression based on findings. | Male 50 years old; Reason: ampullary cancer compare to last CT, measure 1) right basilar pleural based mass, 2) medial pleural based mass, 3) cardiophrenic node, 4) right hepatic lobe lesion, 5) LUQ mass, 6) left omental based mass History: post 2 cycles of chemo CHEST:LUNGS AND PLEURA: Basilar pleural-based masses containing calcifications again visualized. Stable reference right basilar pleural-based mass measuring 4.3 x 1.5 cm, image 79 series 4, previously measured 4.3 x 1.5 cm. More medial reference pleural-based calcification-containing mass stable in size, measuring 2.5 x 1.6 cm, image 75 series 4.MEDIASTINUM AND HILA: Stable to mild interval decrease in size of reference cardiophrenic lymph node measuring 2 x 1.4 cm on image 83 series 4, previously measured 2.2 x 1.5 cm.CHEST WALL: Right chest wall port with tip near cavoatrial junction. Mild calcified coronary artery disease.ABDOMEN:LIVER, BILIARY TRACT: Multiple hypodense masses with internal calcifications again seen. Reference inferiorly located right hepatic mass stable to mildly decreased in size, measuring 8.9 x 4.7 cm, image 125 series 4, previously measured 9.2 x 4.7 cm. Mild intrahepatic biliary duct dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Stable dilatation of pancreatic duct with associated pancreatic parenchymal atrophy. Postoperative changes related to prior pancreaticoduodenal surgery.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys stable in appearance, heterogeneous parenchymal appearance may be treatment related.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Multiple large mesenteric masses. Decreased size of reference left upper quadrant mass measures 9.9 x 8.1 cm, previously measured 10.5 x 7.8 cm. Mass abuts greater curvature of stomach and descending colon with obliteration of intrarenal fat planes, suggesting possible local invasion. Additional left omental based mass is mildly decreased in size, measuring 11 x 7.5 cm, image 137 series 4, previously measured 12 x 7.8 cm.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Destructive right-sided rib disease again seen. | 1. Pleural-based, osseous, nodal, hepatic and omental/peritoneal neoplastic disease, similar in appearance to prior study with stable to mild decrease in size of reference lesions as described. |
Generate impression based on findings. | Multiple myeloma SKULL: Multiple lucencies consistent with venous lakes, no discrete focal changes to support a distinct myelomatous lesionCERVICAL SPINE: Moderate to severe degenerative changes, largely involving the mid cervical spine. Again no discrete focal lesions to support myelomatous involvementTHORACIC SPINE: No significant abnormality noted. LUMBAR SPINE: Limited evaluation due to extensive overlying gas and stool, specifically the left pedicle of the L4 vertebral body is not well visualized, however this may be entirely artifactual. If concern remains high, follow-up imaging can be consideredRIBS: No significant abnormality noted.PELVIS: Limited evaluation due to extensive overlying gas and stool obscuring the upper pelvis. Moderate degenerative changes of both hips and mild disease of both SI jointsUPPER EXTREMITY: Moderate to severe degenerative changes of both shoulders are observed without discrete additional superimposed findings to suggest myelomatous involvement. Forearms are unremarkableLOWER EXTREMITY: Mild tricompartmental degenerative changes of both knees without additional superimposed findings of myelomatous involvement. Lower legs are unremarkable. | Scattered degenerative changes without discrete focal changes to support myelomatous disease. See descriptions level by level above |
Generate impression based on findings. | Elevated lipase and nausea ABDOMEN:LUNG BASES: Calcified hilar lymph nodesLIVER, BILIARY TRACT: 1 cm presumed hemangioma in the right lobe of the liver image number 22, series number 10. Liver is otherwise unremarkable without evidence of biliary dilatation.SPLEEN: Multiple punctate calcifications in the spleen.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: There is a cystic lesion replacing the anterior midpole of the left kidney measuring 2.7 x 2.5 cm on image number 50, series number 10. This lesion has linear calcifications in its lateral wall. This may represent a complicated cyst versus a focal chronic infarct.RETROPERITONEUM, LYMPH NODES: Diffuse atherosclerotic calcifications involving the abdominal aorta and its major branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Fusion of the L4 and L5 vertebral bodies.OTHER: No significant abnormality noted | Unremarkable pancreas. Other findings as described above. |
Generate impression based on findings. | There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is soft tissue crowding at the foramen magnum without evidence of Chiari I malformation. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and extracranial soft tissues are unremarkable. | No acute intracranial hemorrhage or mass-effect. Low-lying cerebellar tonsils without Chiari I malformation.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
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