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Generate impression based on findings. | Female 58 years old Reason: hx of bladder cancer s/p cystectomy, evaluate for metastatic disease with delayed imaging History: see above ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No CT evidence of metastatic disease. |
Generate impression based on findings. | Female 64 years old Reason: 64yo female with stage 1 vaginal cancer s/p ex-lap and LOA for SBO on 1/21, with bowel perforation and enterocutnaeous fistula on 2/4, s/p IR drains 2/5, for re-evaluation of abdomina fluid collections History: abdominal incision wound drainage, abdominal pain ABDOMEN:LUNG BASES: Bilateral small pleural effusions, slightly more on the left side compared to the right. Subsegmental atelectasis at the lung bases.LIVER, BILIARY TRACT: Interval decrease in the size of the collection anterior to the left hepatic lobe, which now measures 1.7 x 2.1 cm image number 28, series number 3. There is a percutaneous drain within this collection.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts. Left nephrolithiasis, unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: More inferior to the collection entered to the left hepatic lobe, there is a percutaneous drain in the midline. No evidence of collection around this drain. There is likely an enteric cutaneous fistula in the midline.There is a third percutaneous drain in the midline. There is a small collection around the drain measuring 2.6 x 1.1 cm on image number 73, series number 3, unchanged from previous study. Mild wall thickening of the bowel loops, again noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Diffuse wall thickening of the bladder, unchanged.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable or minimally decreased intra-abdominal fluid collections. There is a small midline collection which made communicating with the small bowel loops. Clinical correlation is recommended. |
Generate impression based on findings. | Male 70 years old Reason: Evaluate for progression of disease; triple scan liver to evaluate metastatic disease; compare to previous scan History: none CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: The liver is heterogeneous. There are ill-defined hypodense lesions in both lobes of the liver. These lesions cannot be optimally characterized with CT. MRI may be helpful for further evaluation.Index lesion on image number 123 on the previous study is now increase in size and measures 3.4 by 3.3 cm on image number 115, series number 34. Previously measured more inferior lesion is unchanged measuring 4.1 x 3 .5 cm on image number 119, series number 34. Again noted thrombosis of the posterior branch of the right portal vein. Heterogeneity in the left lobe liver is increased suggestive of new focal lesions. MRI of the liver is recommended for further evaluation.SPLEEN: Parasplenic varices.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right nephrolithiasis, unchanged.RETROPERITONEUM, LYMPH NODES: Index preaortic lymph node measures 1 x 1 cm on image number 120, series number 34, not significantly changed from previous study.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Suboptimal study to evaluate the liver. Left lobe of the liver appears more heterogeneous on today's study suggestive of new focal liver lesions. MRI of the liver is recommended for further evaluation. |
Generate impression based on findings. | The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. Myelination is mature. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are essentially clear. | Negative noncontrast brain MRI. Specifically, there are no MRI findings to explain the patient's staring spells. |
Generate impression based on findings. | Reason: Evaluate for progression of metastatic disease; compare to previous scan History: none LUNGS AND PLEURA: Minimal dependent edema or atelectasis.MEDIASTINUM AND HILA: Right chest port tip at RA/SVC junction. Severe coronary calcification.CHEST WALL: Severe degenerative change involving the thoracic spine. | No evidence of pulmonary metastases. |
Generate impression based on findings. | Female 55 years old Reason: Crohn's disease with surgery for previous enterovesical and enterorectal fistula in 2006. ? recurrence of fistula History: Abdominal pain and previous CT with collection ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Hepatomegaly. Liver measures 21 cm in vertical dimension.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There are multiple midline hernias containing nonobstructed small bowel and colon segments. No evidence of bowel obstruction. There is a short segment mild wall thickening and increased enhancement of the ileocolonic anastomosis for about 3 cm, best seen on image number 94, coronal series. These findings may indicate mild active inflammation..BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Short segment mild wall thickening of the ileocolonic anastomosis which may indicate mild active inflammation at the level of the anastomosis. |
Generate impression based on findings. | Female 70 years old Reason: severe abdominal pain, known ho adhesions, CT w/ evidence partial SBO- want to know extent History: abd pain.Additional history from CT report: History provided indicated "colectomy". Transit time to the terminal ileum was no more than one hour and 45 minutes contrast at which time contrast was identified within the rectum. Multiple prominent loops of distal small bowel as identified on recent CT. The small bowel loops were freely mobile during fluoroscopically monitored palpation. Side-to-side anastomosis involving what is taken to be small bowel and is suggestive of ileoileal anastomosis. A colonic bowel pattern was identified within distal small bowel loops consistent with colectomy and "colonization" of the small bowel forming haustral-like markings. Spot films of the terminal ileum were within normal limits. | Multiple prominent loops of distal small bowel as identified on recent CT however contrast passed to the rectum with transit time within normal limits. No evidence of adhesions.Fluoroscopy time: Three minutes and 13 seconds. |
Generate impression based on findings. | Bilateral knee pain Bilateral near severe tricompartmental osteoarthritis mildly greater on the right with near bone-on-bone narrowing. No definite effusions, however small fluid collections cannot be excluded. Mild atherosclerotic changes. | Near severe osteoarthritic changes of both knees, greater on the right |
Generate impression based on findings. | Total hip arthroplasty follow-up Hip: Interval removal of surgical drain. The right total hip arthroplasty remains otherwise unchanged without evidence of new complication. Alignment preserved. Small focal bone chip fracture or possibly heterotopic bone adjacent to the superior acetabulum is unchanged and fixed.Pelvis: Moderate degenerative changes of the opposite hip otherwise similar with more mild degenerative changes of both SI joints. Upper pelvis obscured by extensive gas and stool | Unchanged and uncomplicated right total hip arthroplasty |
Generate impression based on findings. | Male 62 years old Reason: 62 Yrs old man with a history of lymphoplasmacytic lymphoma transformed to DLBCL s/p R-CHOP x6 with near CR, who recently suffered loss of L-sided vision and was found to have leptomeningeal disease treated with MTR x4 History: NHL CHEST:LUNGS AND PLEURA: Emphysema. Bronchiectasis at the lung bases. Subsegmental atelectasis.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of enlarged lymph nodes.Bronchiectasis in the bilateral lower lobes, more prominent on the left side and emphysema. |
Generate impression based on findings. | Cast revision Detail obscured by overlying splint material. Gross anatomic alignment with mild volar angulation remains observed involving the fifth metacarpal neck fracture. | Mild persistent volar angulation involving the fifth metacarpal fracture |
Generate impression based on findings. | Male 82 years old Reason: diverticulitis vs. appendicitis History: lower abdominal pain, ABDOMEN:LUNG BASES: Bilateral pleural effusions and atelectasis, new from previous study.LIVER, BILIARY TRACT: Stable hepatic cysts.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts unchanged. Some of the renal lesions are too small to accurately characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small amount of ascites, new from previous study.BONES, SOFT TISSUES: Again noted sclerotic bone lesions consistent with metastatic disease. Multiple compression fractures of the vertebral bodies likely secondary to osteoporosis.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: A long segment of the sigmoid colon is collapsed and demonstrates diffuse mild wall thickening. This may represent diffuse colitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: Penile prosthesis reservoir. | Interval development of bilateral pleural effusions and small amount of ascites.Diffuse wall thickening of a long segment of sigmoid colon suspicious for colitis. |
Generate impression based on findings. | Ankle fracture.VIEWS: Right ankle AP/lateral/oblique (3 views) 02/23/15 Two screws remain in place in the tibial epiphysis. Alignment is anatomic. The fracture has healed. | Postoperative changes. |
Generate impression based on findings. | Lumbago Mild scoliosis without evidence of discrete superimposed focal lumbar abnormality. Specifically lumbar bodies, disk spaces and alignment are preserved. SI joints are intact. Questionable minimal degenerative changes with facet sclerosis involving the lower levels | Questionable minimal osteoarthritic changes of the lower lumbar levels without associated additional focal abnormality |
Generate impression based on findings. | Cannot bear weight. Check for fracture. Pain and swelling Minimal diffuse soft tissue swelling without underlying osseous abnormality. Specifically no acute fractures or malalignment. Os trigone observed, a normal variant | Minimal soft tissue swelling without acute abnormality |
Generate impression based on findings. | Hypodensity is present within the white matter without associated mass effect. The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral or cerebellar cortical infarction. There are no extraaxial fluid collections or subdural hematomas. Mucosal thickening is present within the left maxillary and a few left ethmoid air cells. The remaining visualized visualized portions of the paranasal sinuses and mastoid air cells are clear. | Small vessel ischemic disease of indeterminate ages. If there is continued clinical concern for acute ischemia, MRI would be recommended. |
Generate impression based on findings. | Cervical stenosis. Planning cervical fusion. Pain Anterior fixation of C5-6 is observed with associated fusion at this level. Alignment otherwise preserved. No evidence of instability with only minimal degenerative changes observed proximally. Lower cervical spine is also less well visualized due to overlapping structures.Soft tissues are unremarkable | Fusion of C5-6 with anterior fixation |
Generate impression based on findings. | Female 63 years old Reason: +FOB, incomplete initial colonoscopy due to stricture; chronic inactive Hep B with viral load <100 History: source of positive stool for occult blood; colonoscopy done 4/7, unable to advance colonoscope past hepatic flexure due to resistance; incomplete colonoscopy. Hx Hep B, viral load <100 (11/4/13) The scout film showed a nonspecific bowel gas pattern without any evidence of obstruction or ileus. Barium flowed freely from the rectum to the cecum. Marked tortuosity and redundancy of the sigmoid colon and somewhat traverse colon is noted. There is no evidence of obstructing or constricting lesions. The colonic mucosa is normal in appearance with no evidence of ulceration, edema, mass lesions or polyp. Small ascending colon diverticulae noted. Small amounts of barium and air were refluxed into the terminal ileum. Spot films of the terminal ileum were normal. The appendix was visualized and is normal in appearance. | Marked tortuosity and redundancy of the colon with scattered small ascending colon diverticulae. No significant sized polyps seen.Fluoroscopy time: Six minutes and 12 seconds. |
Generate impression based on findings. | Male 86 years old; Reason: 86 M with HCC s/p TACE, please evaluate for response to TACE. ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: On noncontrast portion of the exam, amorphous radiodensity seen in right hepatic lobe, within patient's dominant hepatic segment 7/6 mass. Again seen are multiple heterogeneously enhancing bilobar hepatic lesions. Essentially stable size of dominant mass accounting for differences in technique, measuring 13.4 x 10.6 x 14.6 cm in craniocaudal dimension, previously measured 12.6 by 10.9 x 14.9 cm, distribution and degree of enhancement similar to prior study. As seen on prior study, in subsequent venous phase of imaging, dominant mass demonstrates areas of intralesional washout, subsequent mild hypoattenuation of other lesions seen in venous phase as well.The discrete lesions in the left hepatic lobe demonstrate interval enlargement. Representative hepatic segment 2 lesion measuring 3.7 x 3 cm, image 24 series 9, previously measured 2.7 x 2.2 cm. Hypervascular areas seen in the periphery of both left and right hepatic lobes without definite washout in venous phase/areas appear isodense on delayed phase, may reflect perfusion abnormalities but nonspecific. One of these foci located in right hepatic lobe in hepatic segment 5 increased in size, measuring 1.2 x 0.7 cm, image 42 series 9, previously measured up to 0.3 cm, again indeterminate but additional neoplastic foci a consideration.Stable mild intrahepatic biliary duct dilatation, right hepatic venous luminal narrowing, thrombosed posterior branches of right portal vein. SPLEEN: No significant abnormality noted.PANCREAS: Stable in appearance.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Kidneys stable in appearance, including lobulated exophytic left renal cyst and additional left renal hypoattenuating lesion too small to characterize.RETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerotic disease. Status post endovascular aortic repair with unchanged infrarenal abdominal aortic aneurysm present, stable in size measuring approximately 5.2 x 5.1 cm. Again seen is a type II endoleak, appears to be supplied by inferior mesenteric artery. Aneurysmal right common iliac artery and ectatic left common iliac artery as well as ectatic external iliac arteries.BOWEL, MESENTERY: Extensive left-sided colon diverticulosis without evidence of acute diverticulitis.PELVIS:PROSTATE/SEMINAL VESICLES: Enlarged calcification-containing prostate gland, with TURP defect suggested.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Visualized osseous structures stable in appearance. Multilevel degenerative changes of spine. Left ventral abdominal 1.7 cm focus of skin thickening, image 68 series 11. | 1. Multifocal hepatocellular carcinoma with posttreatment sequela as above. 2. Endovascular aortic repair with type II endoleak. |
Generate impression based on findings. | Female 81 years old Reason: eval esophageal motility History: reflux Scout radiograph of the chest showed no mediastinal widening, or pleural effusions. Stable appearance of a 2.2-cm well-defined right upper lobe opacity.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces or mural contours. Fluoroscopic evaluation of esophageal peristalsis demonstrated hold up in the distal esophagus with proximal escape and tertiary contractions consistent with a mild motility disorder. There was a small hiatal hernia noted and mild spontaneous reflux of contrast into the lower esophagus.TOTAL FLUOROSCOPY TIME: Four minutes and 26 seconds | 1. Mild esophageal motility disorder. 2. Small hiatal hernia with mild gastroesophageal reflux demonstrated. |
Generate impression based on findings. | 36 year old with newly diagnosed right breast cancer presents for bilateral mammogram. Three standard views of both breasts and bilateral spot views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses. Biopsy proven cancer in the right upper outer quadrant measures 2.1-cm and has associated biopsy clip artifact. An area of focal asymmetry inferior to the mass largely disperses with spot compression. An abnormal right axillary lymph node is also noted, with a biopsy clip seen anterior to the lymph node. Areas of asymmetry in the left upper outer breast largely disperse on spot compression and are more compatible with dilated ducts given the patient's history of recent pregnancy. No suspicious microcalcifications or areas of architectural distortion in either breast. ULTRASOUND | Biopsy proven malignancy in the right breast and biopsy proven metastatic right axillary lymph node. No additional suspicious mammographic or sonographic findings. The patient is seeing Dr. Jaskowiak today. Breast MRI is suggested based on her breast density and young age at cancer diagnosis. BIRADS: 6 - Known cancer.RECOMMENDATION: T - Take Appropriate Action - No Letter. |
Generate impression based on findings. | Pain, follow-up questionable tibial plateau fracture No acute or subacute fracture abnormality observed in follow-up imaging. No effusion. Alignment preserved. Minimal degenerative changes similar to prior studies | Minimal osteoarthritis without additional new acute or subacute fractures |
Generate impression based on findings. | HTN and cognitive impairment with memory loss. There is no evidence of acute intracranial hemorrhage or mass. The ventricles are normal in size and configuration. There are right vertebral artery calcifications. There is no midline shift or herniation. The mastoid air cells are clear. There is minimal mucosal thickening in the The skull and scalp soft tissues are unremarkable. | No evidence of acute intracranial hemorrhage or mass. |
Generate impression based on findings. | Bilateral severe-profound hearing loss. Left: There is marked stenosis of the cochlear aperture, which measures less than 1 mm in width. The internal auditory canal is otherwise not particularly narrow, measuring approximately 4 mm in diameter. There is focal paucity of bone overlying the superior semicircular canal. The other semicircular canals and vestibular are otherwise intact. The vestibular aqueduct is not enlarged. The middle ear, mastoid antrum, and mastoid air cells are almost completely opacified. The ossicular chain is intact. The external auditory canal is patent, but contains a small opacity that likely represents cerumen. The facial nerve describes a normal course. The jugular bulb and carotid canal are intact. Right: There is marked stenosis of the cochlear aperture, which measures less than 1 mm in width. The internal auditory canal is not particularly narrow, measuring approximately 4 mm in diameter, and the semicircular canals and vestibular are otherwise intact. The vestibular aqueduct is not enlarged.The middle ear, mastoid antrum, and mastoid air cells are completely opacified. The ossicular chain is intact. The external auditory canal is patent. The facial nerve describes a normal course. The jugular bulb and carotid canal are intact. Miscellaneous: There are mildly prominent extra-axial CSF spaces in the middle cranial fossa bilaterally. There is also scattered paranasal sinus opacification. | 1. Bilateral severe cochlear aperture stenosis is compatible with cochlear nerve deficiency. Please refer to the separate MRI for additional details.2. Suggestion of focal left superior semicircular canal dehiscence.3. Bilateral nonspecific otomastoid opacification.4. Scattered paranasal sinus opacification. |
Generate impression based on findings. | Swelling and pain There is an oblique fracture of the distal fibula extending to the level of the tibiotalar joint, with ~2 mm of lateral displacement of the distal fracture fragment. There is also a transverse fracture through the medial malleolus with fracture fragments in near anatomic alignment. A small linear density along the anterior aspect of the tibial plafond likely represents an additional avulsion fracture. There is soft tissue swelling particularly along the anterolateral aspects of the ankle. | Distal fibular and tibial fractures. |
Generate impression based on findings. | Status post hardware removal and replacement. Evaluate bone fusion to lumbar spine, evaluate sagittal balance. Surveillance imaging. The previously seen posterior lumbosacral fixation device has been removed and replaced with new posterior rods and screws that enter the L2 through S1 vertebrae, with additional screws entering both iliac wings. The tips of the L3 screws overlie the superior endplate of the L3 vertebral body, but this appears similar to that seen on prior studies. In addition to the previously seen spacer devices at L4/5 and L5/S1, there are new devices at L2/3 at L3/4. Bone graft is also seen along the lateral aspect of the lower lumbar spine. There may be early bony bridging of the lower lumbar vertebrae, but this is equivocal. I see no frank interbody fusion between L2, L3, and L4. There is sclerosis and a grade 1 retrolisthesis of L2 that appears similar to that seen on the prior study. Evaluation of the lower cervical spine and upper thoracic spine is limited on the lateral view due to overlying anatomy. Degenerative disk disease appears to affect the lower cervical spine. Sagittal balance is within normal limits. Interstitial lung disease would be better evaluated with dedicated chest radiographs. | Postoperative changes of lumbosacral fusion as described above; sagittal balance is within normal limits. |
Generate impression based on findings. | Reason: Assess for SVC syndrome or proximal clot History: RUE swelling LUNGS AND PLEURA: Mild left lower lobe atelectasis with a small pleural effusion. Stable scattered calcified and noncalcified micronodules,unchanged. Chronic atelectasis of the anterior segment of the right upper lobe; the aerated segment of the bronchus is decreased in size, presumably due to increased debris distally.MEDIASTINUM AND HILA: Severe coronary calcification. Scattered small subcentimeter nodes. Esophageal varices.Right brachiocephalic vein and SVC are widely patent. Central aspect of left brachiocephalic vein is widely patent though there there is severe chronic narrowing at the left jugular/subclavian vein confluence possibly secondary to previous central venous catheters, not significantly changed from multiple previous.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Ascites, cirrhotic liver. | Right brachiocephalic vein and SVC are widely patent. Central aspect of left brachiocephalic vein is widely patent though there there is severe chronic narrowing at the left jugular/subclavian vein confluence possibly secondary to previous central venous catheters, not significantly changed from multiple previous. |
Generate impression based on findings. | 33 years, Female, Reason: kidney stones? History: urethral pain. RIGHT KIDNEY: The right kidney measures 11.7 cm in length. Mild right sided hydronephrosis. No definite stone.LEFT KIDNEY: The left kidney measures 11.9 cm in length. No evidence of hydronephrosis or hydroureter. There is a nonobstructing stone in the left inferior pole measuring 0.9 x 0.7 x 0.5 cm.BLADDER: There is a stone within the bladder measuring 0.8 x 0.4 x 0.6 cm.OTHER: No significant abnormalities noted. | 1.Mild right-sided hydronephrosis and stone within the bladder, which may be recently passed. However mild hydronephrosis may be seen at this stage in pregnancy.2.Nonobstructing stone in the left lower pole there |
Generate impression based on findings. | Female 61 years old; Reason: LUQ abdominal pain History: as above ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Mid right renal hypodensity, likely parapelvic cyst.RETROPERITONEUM, LYMPH NODES: Moderate calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Likely fibroid uterus, some of which are partially calcified and others with suggestion of internal necrosis, measuring up to 6.6 cm.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral metallic hardware in both hips, limits evaluation in the lower pelvis secondary to streak artifact.OTHER: No significant abnormality noted. | 1.No definite CT findings to account for patient's left upper quadrant pain.2.Fibroid uterus. |
Generate impression based on findings. | Prostate cancer and rising PSA. Please compare to previous exam. No abnormal osseous foci are identified to indicate metastatic disease.Foci of increased uptake are noted in the cervical spine, acromioclavicular joints, and lower lumbar spine, which is similar to the prior examination and likely represents degenerative changes. | No evidence of bone metastases. |
Generate impression based on findings. | Female; 58 years old. Reason: follow up lung cancer. CHEST:LUNGS AND PLEURA: Postoperative changes again noted in the right upper lobe. Soft tissue thickening around the suture line is stable and likely reflects scarring. Moderate upper lobe predominant centrilobular emphysema. No 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. Mild aortic and coronary calcifications.CHEST WALL: Diffuse spinal trabecular thickening is unchanged. Sclerotic changes in the right ribs are compatible with healed fractures.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: Stable bilateral renal cysts and nonobstructive right renal calculi.PANCREAS: Mild pancreatic ductal dilatation, unchanged. No suspicious pancreatic lesions.RETROPERITONEUM, LYMPH NODES: No retroperitoneal or mesenteric lymphadenopathy. Severe atherosclerotic calcification of the aorta and its major branches with some mural thrombus noted just before the aortic bifurcation.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Diffuse spinal trabecular thickening is unchanged.OTHER: No significant abnormality noted. | Postoperative changes and likely scarring in the right upper lobe without suspicious pulmonary nodules or evidence of metastatic disease. |
Generate impression based on findings. | 65 year old woman with history of metastatic carcinosarcoma of the uterus, s/p debulking, evaluate for metastatic disease. CHEST:LUNGS AND PLEURA: Scattered nonspecific calcified and uncalcified pulmonary micronodules, not significantly changed. No new suspicious nodules or masses. Multiple thin-walled pneumatoceles appearing similar to prior. No consolidation or pleural effusions.MEDIASTINUM AND HILA: Subcentimeter mediastinal lymph nodes not significantly changed. Moderate coronary artery calcifications. Left-sided pacemaker device appearing similar to prior. CHEST WALL: Left-sided chest port with catheter tip at the SVC atrial junction. ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. There is a low attenuation lesion along the periphery of hepatic segment IVb (series 3, image 91) measuring 2.0 x 1.9 cm new from the prior exam and suspicious for a metastatic lesion. There is an additional low-attenuation lesion along the periphery of hepatic segment 7 (series 3, image 72) also suspicious for a metastatic lesion.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: Prominent retroperitoneal lymph nodes are present, increased from prior.BOWEL, MESENTERY: Numerous mesenteric and peritoneal nodules are present compatible with metastatic disease overall increased in size and number compared to the prior exam. An example nodule inferior to the inferior tip of the liver (series 3, image 116) measures 1.5 x 1.7 cm. BONES, SOFT TISSUES: Interval postsurgical changes in the anterior abdominal wall. Moderate degenerative changes of the visualized thoracolumbar spine. PELVIS:UTERUS, ADNEXA: Interval postsurgical changes of hysterectomy.BLADDER: No significant abnormality noted.LYMPH NODES: Multiple enlarged pelvic lymph nodes are present some of which appear necrotic and are suspicious for metastatic disease, increased from prior, for example, left external iliac lymph node (series 3, image 154). BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Right-sided total hip arthroplasty device appearing similar to prior. Metallic streak artifact from the device partially obscures adjacent structures the pelvis. Severe degenerative changes affect the left hip. OTHER: Multiple soft tissues nodules are present in the pelvis suspicious for metastatic disease, increased from prior. An example mesorectal nodule (series 3, image 156) measures 2.8 x 4.5 cm. | 1.Post surgical changes of interval hysterectomy.2.Widespread metastatic disease in the abdomen and pelvis increased from prior including hepatic capsular implants, peritoneal implants, pelvic soft tissue nodules and pelvic lymphadenopathy. |
Generate impression based on findings. | 57-year-old female with metastatic breast cancer post 8 cycles of Taxol. Restaging. CHEST:LUNGS AND PLEURA: Previously noted subpleural nodules in the right middle and right lower lobe are no longer identified. There is minimal scarring in the location of prior nodules. There is mild and somewhat linear pleural thickening at the right lung base laterally and image 76/98.MEDIASTINUM AND HILA: Small pericardial effusion without change.CHEST WALL: Pacer left chest.Progressive, asymmetric thickening of the skin of the right breast which is incompletely included in the field of view.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: There is almost complete atrophy of the pancreatic substance. There is dilatation the pancreatic duct with multiple calcifications within and outside the duct. There is a more discrete cystic area in the extreme pancreatic tail measuring 2.1 x 1.9 cm on image 91/207 with eccentric wall calcifications, and small associated adjacent cystic areas. This is slightly larger than on prior exam there is good and underlying cystic pancreatic mass. A thrombosed splenic artery aneurysm would be a secondary consideration.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Mild thickening of jejunal loops in left upper quadrant of uncertain etiology. No gross evidence for obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Calcified fibroid.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. | Resolution of previously noted subpleural lung nodules.Mild, focal pleural thickening right lung base.Severe pancreatic atrophy with findings of chronic pancreatitis. There is likely a separate cystic lesion in pancreatic tail. If further clinical information is needed, M.R.C.P. may be helpful.Calcified uterine fibroid.Small pericardial effusion, unchanged. |
Generate impression based on findings. | 59 years, Male. Reason: Dobbhoff and OG tube placement History: Dobbhoff and OG tube placement Motion degrades the study. Multiple chest tubes, drains, surgical staples and clips are noted. OG tube is noted with tip projecting over the gastric antrum. Dobbhoff tube is looped with tip projecting over the fundus although obscured by overlying catheters. Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | Limited examination due to motion. OG tube projects over over the gastric antrum. Dobbhoff tube projects over the gastric fundus although tip is not clearly visualized. |
Generate impression based on findings. | Male 80 years old Reason: s/p IM rod left proximal femur pathologic fx History: above An intramedullary rod and screw device is again seen affixing a femoral neck fracture in near-anatomic alignment. The fracture remains visible, although portions are slightly less distinct on the current study than on the prior study suggesting some interval healing. There appears to have been slight lateral retraction of the inferior of the two femoral neck screws when compared to the prior study. Furthermore, there is a new fracture through the screw within the distal femur. Lucency within the underlying bone is compatible with known history of multiple myeloma. | Orthopedic fixation of proximal femoral fracture with proximal screw retraction and distal screw fracture as described above. |
Generate impression based on findings. | There is encephalomalacia and gliosis within the left MCA territory distribution associated with ex vacuo dilatation of the adjacent left lateral ventricle, evidence for evolving old left MCA infarct. Elsewhere there is confluent hypodense abnormality throughout the white matter without associated mass effect. Incidental note is made of a focal osseous structure along endosteum of the left frontal bone which most likely reflects a small meningioma, without significant effect upon underlying brain parenchyma. There are no masses, mass effect or midline shift. There is no evidence for acute intracranial hemorrhage. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are clear. | 1.Evolving old left MCA infarct.2.Advanced small vessel ischemic disease of indeterminate ages. If there is continued clinical concern for acute ischemia, MRI would be recommended.3.Incidental note is made of a focal osseous structure along endosteum of the left frontal bone which most likely reflects a small meningioma, without significant effect upon underlying brain parenchyma. |
Generate impression based on findings. | History of breast cancer with metastatic disease in supraclavicular node. Evaluate extent of disease. No abnormal osseous foci are identified to indicate metastatic disease.There are foci of increased uptake within the right lateral 6th and 7th ribs, which correspond to healing fractures on a recent CT. Additional foci of uptake in the shoulders and knees is likely degenerative. | No evidence of bone metastases. |
Generate impression based on findings. | Reason: LUL nodule. Navigation protocol please History: dyspnea LUNGS AND PLEURA: A spiculated left upper lobe nodule measures 1.3 x 1.3 cm (series 6, image 61), slightly increased from the prior CT exam dated 11/2014, and hypermetabolic on recent PET imaging. Adjacent scarring and an adjacent additional punctate solid nodule (series 6, image 67) appear unchanged. Additional scattered micronodules are stable. No new suspicious nodules or masses.Minimal basilar subsegmental atelectasis/scarring. No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without significant pericardial effusion. Severe coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: Status post left mastectomy. Scoliosis of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Atherosclerotic calcification of the abdominal aorta and its branches. Scattered colonic diverticula partially visualized. | Left upper lobe 1.3 cm nodule is highly suspicious for malignancy, including primary lung neoplasm vs metastasis. |
Generate impression based on findings. | Female 30 years old Reason: eval LT wrist IN CAST History: pain. Evaluation of fine bone detail is limited by overlying cast. Again seen is a transverse fracture of the distal radius with fracture fragments in near anatomic alignment. The fracture line remains visible, but there is callus formation dorsally suggesting some interval healing. The ulnar styloid fracture seen on prior studies is not evident on the current study. | Healing distal radius fracture as above. |
Generate impression based on findings. | Female 30 years old Reason: eval fracture History: pain. Three views of the right wrist show a comminuted intra-articular fracture of the distal radius with fracture fragments in near anatomic alignment. | Comminuted intra-articular fracture of the distal radius with fracture fragments in near-anatomic alignment. |
Generate impression based on findings. | Reason: hypoxemia, dyspnea History: hypoxemia, dyspnea LUNGS AND PLEURA: Punctate micronodule in right upper lobe is stable and consistent with a postinflammatory nodule (image 49/92)MEDIASTINUM AND HILA: Right chest port at RA/SVC junction. Scattered small nodes are unchanged.CHEST WALL: Spinal stimulation device. Small axillary nodes are unchanged.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | No acute cardiopulmonary abnormality. |
Generate impression based on findings. | Male 81 years old; Reason: 81 y/o M with marginal zone lymphoma in the setting of active mycobacterial infection. please evaluate for progression. CHEST:LUNGS AND PLEURA: Trace left pleural effusion. Again seen is left upper lobe consolidation, area measures approximately 8.8 x 5.4 cm. Multiple cystic areas seen within area, likely due in part to air bronchograms but superimposed infection/underlying pulmonary parenchymal necrosis a consideration. No significant change in size from prior PET/CT study accounting for differences in technique. Also seen is right lower lobe cavitary lesion measuring approximately 3.5 x 2.8 cm with surrounding rim of air space disease, similar to earlier exam. MEDIASTINUM AND HILA: Mildly prominent mediastinal lymph nodes seen. Representative pretracheal lymph node measuring 1.5 x 1 cm, image 34 series 3, previously measured 1.5 x 1.3 cm. Small supraclavicular lymph nodes also seen. Mild calcified coronary artery disease.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: Enlarging splenic lesion, suspicious for metastatic disease, lesion measures 2.5 x 3 .1 cm, image 87 series 3, previously measured 1.7 x 1.4 cm.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Bilateral adrenal lesions, demonstrating mild interval increase in size. Left adrenal lesion measures 1.7 x 1.6 cm, previously measured 1.5 x 1.5 cm.KIDNEYS, URETERS: Kidneys stable in appearance including right-sided renal cysts.RETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerotic disease. New retroperitoneal lymphadenopathy present, reference left paraaortic lymph node measuring 1.4 x 1.3 cm on image 131 series 3. BOWEL, MESENTERY: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate with heterogeneous hypoattenuated appearance particularly in left aspect of gland, image 194 series 3, hypertrophy of median lobe. Correlation with patient's clinical history and serum PSA values recommended.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Multilevel degenerative changes of spine and hip degenerative disease seen. | 1. Stable left upper lobe consolidation, right lower lobe cavitary lesion and trace left pleural effusion. Multiple cystic areas seen within left upper lobe consolidation, likely due in part to air bronchograms but appearance worrisome for superimposed infection/underlying pulmonary parenchymal necrosis. 2. Mildly prominent mediastinal and supraclavicular lymph nodes again seen, unchanged in size, demonstrated FDG avid activity on prior PET imaging and again suspicious for metastatic disease.3. Enlarging splenic and adrenal metastases. 4. New enlarged enteroperitoneal adenopathy, suspicious for new metastatic disease.5. Enlarged prostate with heterogeneous hypoattenuated appearance particularly in left aspect of gland, hypertrophy of median lobe. Findings may reflect benign prostatic hyperplasia but correlation with patient's clinical history and serum PSA values recommended. |
Generate impression based on findings. | Female; 54 years old. Reason: met breast cancer History: on anastrazole CHEST:LUNGS AND PLEURA: Moderate dependent scarring and scattered subpleural and parenchymal cysts. No pleural effusions or focal areas of consolidation. No suspicious pulmonary nodules or masses. Punctate left upper lobe granuloma.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No significant coronary calcifications. Prominent precarinal lymph node measures 9 x 9 mm, unchanged (series 3, image 37). No new mediastinal or hilar lymphadenopathy. Scattered calcified mediastinal lymph nodes are compatible with prior granulomatous disease.CHEST WALL: Status post right mastectomy with placement of subpectoral breast implant. No axillary lymphadenopathy. Sclerotic lesion in the T3 vertebral body is unchanged.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No focal hepatic lesions or biliary ductal dilatation. Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Indeterminate left adrenal nodule is unchanged (series 3, image 93).KIDNEYS, URETERS: Stable left mid pole cyst. No suspicious renal lesions or hydronephrosis.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: Sclerotic lesion in the T3 vertebral body is unchanged. Expansile soft tissue mass involving the inferior left L5 vertebral body is partially visualized. Lumbosacral fusion hardware is again noted.OTHER: No significant abnormality noted. | 1.Partially visualized expansile soft tissue mass involving the L5 vertebral body and sclerotic lesion in the T3 vertebral body are compatible with osseous metastases. Please see prior bone scan and today's bone scan reports for additional details.2.Postsurgical changes as described above without evidence of new metastatic disease. |
Generate impression based on findings. | History of metastatic breast cancer on treatment. There is faint increased uptake in the left acetabulum appearing similar in size and intensity as the prior examination. No new areas of abnormal uptake are identified. | Stable left acetabular osseous lesion which in combination with a prior CT remains suspicious for metastatic disease. |
Generate impression based on findings. | ConstipationVIEW: Abdomen AP Minimal amount of fecal burden without evidence of obstruction. No abnormal bowel dilation. No pneumatosis or pneumoperitoneum. | Minimal amount of fecal burden without evidence of obstruction. |
Generate impression based on findings. | Ms. Gerling is a 48 year old female with history of bilateral benign calcifications. Personal history of cervical cancer diagnosed at the age of 28. Family history of breast cancer in mother. Three standard views of both breasts, a right laterally exaggerated CC view, and two spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Focal asymmetry identified in the right inferior breast disperses into normal breast parenchyma on the spot compression views. Scattered benign calcifications, including coarse benign calcifications in the left retroareolar region, are present bilaterally. There are no suspicious microcalcifications or areas of architectural distortion identified in either breast. | Bilateral benign calcifications. 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: 79 F w/ apical nodule, please assess for growth LUNGS AND PLEURA: A left apical pleural nodular thickening is stable from the prior exam dated 11/2014. This is difficult to accurately measure on axial imaging, measuring approximately 28 x 19 mm (series 4, image 8). On coronal images it measures 17 x 9 mm (coronal image 32) stable from the prior exam. There is no associated osseous destruction or pleural reaction.Right apical scarring is unchanged.Left upper paramediastinal cystic lung lesion appears similar to the prior exam.Additional scattered micronodules, some calcified, are unchanged.MEDIASTINUM AND HILA: The heart is normal in size, with trace pericardial fluid/thickening. No visible coronary artery calcifications.Moderate sized hiatal hernia.CHEST WALL: Degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Stable appearance of a left apical pleural-based nodular opacity. Recommend continued followup imaging in 6 months to 1 year. No other acute abnormality. |
Generate impression based on findings. | Reason: bleed/abnormality History: right sided ha and pressure post mvc yesterday There is a 59 x 54 mm sagittal dimension CSF density lesion in the posterior fossa associated with adjacent bone remodeling. The cerebellum is displaced anteriorly.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.A large cystic lesion in the posterior fossa with associated displacement of the cerebellum and bone remodeling most likely represents a large arachnoid cyst. This can be confirmed with MRI if clinically appropriate. |
Generate impression based on findings. | 49 year old male with dysphagia. Reports food gets stuck in the throat. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed a moderate hiatal hernia measuring up to 3.3 cm and a Schatzki's ring narrowed to approximately 11 mm. The Schatzki's ring was obstructive to a 13 mm barium pill. During the exam, no spontaneous and provoked gastroesophageal reflux was observed. Fluoroscopic evaluation of esophageal peristalsis demonstrated a normal primary peristaltic wave with delayed transit through the Schatzki's ring.Incidentally noted is new grade 1-2 anterolisthesis of C4 over C5. TOTAL FLUOROSCOPY TIME: 4:59 minutes | 1.Schatzki's ring obstructive to a barium pill. 2.Moderate hiatal hernia. 3.New grade 1-2 anterolisthesis of C4 over C4. |
Generate impression based on findings. | 13 year-old male with worsening abdominal pain, nausea/vomiting. Evaluate for free air, obstruction.VIEWS: Abdomen AP supine and upright (two views) 2/23/2015 Multiple dilated small bowel loops with air-fluid levels compatible with small bowel obstruction. No evidence of pneumatosis intestinalis, pneumoperitoneum, portal venous gas or ascites. | Findings compatible with small bowel obstruction. Findings were discussed with Dr. Theodore De Beritto by phone on 2/23/2015 at 2:35 PM. |
Generate impression based on findings. | Female 46 years old Reason: 46 F with metastatic anal cancer s/p RFA with perihepatic hematoma, please evaluate for interval change since prior CT. ABDOMEN:LUNG BASES: No significant abnormality noted LIVER, BILIARY TRACT: Postprocedural changes of radiofrequency ablation of the previously described segment 6/7 hypoattenuating lesion, with decreasing region of hypoattenuation extending linearly along the ablation tract through the right hepatic lobe. The hypoattenuation measures 5.4 x 1.4 cm (series 3, image 26), previously 5.4 x 1.8 cm. A wedge-shaped area of low attenuation in the right hepatic lobe is stable in size, with stable foci of increased attenuation peripherally (series 3, image 24) now measuring 0.8 x 0.6 cm, previously 0.9 x 0.7 cm. A hypoattenuating focus adjacent to the hepatic veins also appears unchanged (series 3, image 19). There is a small mixed density perihepatic fluid collection measuring 4.2 x 0.9 cm (series 3, image 22), previously 4.4 x 1.1 cm, likely representing a resolving hematoma. No acute hemorrhage.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality noted | Postprocedural changes of radiofrequency ablation with small perihepatic fluid collection, favor resolving hematoma. Decreased size of postablation cavity. Remainder of study without significant change. |
Generate impression based on findings. | 73-year-old male with history of seizures and lymphoma. Evaluate for malignancy. There is no evidence of acute intracranial hemorrhage. The gray-white differentiation is preserved. No midline shift or mass effect. The basal cisterns are intact. The ventricles and sulci are symmetric. The imaged paranasal sinuses and mastoid air cells are clear. The calvarium and soft tissues of the scalp are within normal limits. | No acute intracranial abnormality or malignancy as clinically queried. |
Generate impression based on findings. | Reason: primary hyperparathyroidism History: hypercalcemia There are several nodules present in the soft tissues of the lower neck . Their locations and serial Hounsfield units on dynamic CT or listed below along with some density units of normal structures:Houndsfield units through nodules (0seconds, 25 seconds, 55 seconds, 85 seconds):Right Carotid artery (image # 152 ):: 54.21HU, 459HU, 233HU, 209HURight Jugular vein (image # 152 ):: 56.1HU, 402HU, 248HU, 216HURight submandibular gland (image # 152 ): 59.3HU, 85.0HU, 133HU, 127HURight sternocleidomastoid muscle: (image # 152 ): 75.6HU, 81.2HU, 84.3HU, 78.4HULymph node (image # 108 ): 53.0HU, 85.7HU, 120.4HU, 121.4HURetrosternal nodule image 7x9mm anterior to the pulmonary trunk (image # 435-440 ): 29.6HU, 207HU, 130HU, 116 HU.CT neck:Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland has been removed.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The inferior aspects of the mastoid air cells are clear. The visualized inferior aspects of the maxillary sinuses are clearThe parotid and the submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. There degenerative changes present with endplate and uncovertebral osteophytes at the C5-6 where there is a narrowing of the neural foramina and mild narrowing of the spinal canal.Parathyroid sampling:Intraprocedural images demonstrate the location of venous sampling.Reported PTH, Intact values (REF 15-75 pg/mL):FEMORAL VEIN: 123SUPERIOR VENA CAVA: 136INNOMINATE VEIN JUNCTION: 206LEFT INNOMINATE VEIN: 122LEFT INTERNAL JUGULAR VEIN, LOWER: 131LEFT INTERNAL JUGULAR VEIN,MID: 117LEFT INTERNAL JUGULAR VEIN, UPPER: 118RIGHT INTERNAL JUGULAR VEIN, LOWER: 123RIGHT INTERNAL JUGULAR VEIN, MID: 116RIGHT INTERNAL JUGULAR VEIN, UPPER: 121 | 1.There is a 9mm anterior mediastinal nodule located behind the sternum and towards the left, anterior to the pulmonary trunk which is suspicious for a parathyroid adenoma based on contrast uptake on dynamic CT.2.Parathyroid venous sampling.3.Degenerative changes of the cervical spine are worse at C5-6 as detailed above. |
Generate impression based on findings. | 4-month-old male with placement of NJ tube.VIEW: Abdomen AP (one view) 2/23/2015 14:01 Feeding tube tip coiled in the left upper quadrant likely in the stomach.Disorganized bowel gas pattern with no evidence of obstruction. | Feeding tube tip coiled and likely in the stomach. |
Generate impression based on findings. | Reason: evaluate ILD History: cough soboe fibrosis LUNGS AND PLEURA: There are low lung volumes.Basilar predominant subpleural reticulation with mild architectural distortion, traction bronchiectasis, and groundglass opacities . No honeycombing identified.Postsurgical changes are noted in the left lower lobe related to a prior wedge resection.Bilateral pleural calcifications with a small loculated left pleural effusion.Mild basilar scarring/discoid atelectasis.No suspicious pulmonary nodules or masses..MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy identified.Cardiac enlargement without evidence of pericardial effusion.Moderate coronary calcification.Evidence of a prior CABG.CHEST WALL: Status post median sternotomy.Impression deformities of multiple thoracic vertebrae of indeterminate age.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | 1.Basilar predominant interstitial fibrosis compatible with possible fibrosing NSIP. This may be idiopathic in origin. However, the differential diagnosis would include mixed connective tissue disease as well as possible drug toxicity.2.Cardiac enlargement with small loculated pleural effusion.3.Multiple thoracic vertebral compression deformities of indeterminate age. |
Generate impression based on findings. | 75 years, Female, Reason: severe post procedure pancreatitis History: recent admission at OSH with CT w/o contrast. ABDOMEN:LUNG BASES: Small left pleural effusion, decreased from the prior exam. Resolution of right pleural effusion.LIVER, BILIARY TRACT: Borderline enlarged liver. Left hepatic dome lesion is stable.SPLEEN: Small splenule. Nonspecific splenic hypodensity is unchanged.PANCREAS: There is peripancreatic stranding compatible with history of acute pancreatitis. While mesenteric fluid is decreased, there are now new organizing peripancreatic fluid collections. A collection along the greater curvature of the stomach, anterior to the tail of the pancreas measures approximately 4.6 x 2.5 cm (3/32). An additional component to this collection more anteriorly measures 3.5 x 2.8 cm (3/38). A collection anterior to the head of the pancreas measures 5.3 x 2.4 cm and extends in to the hepatic hilum. Normal enhancement of the pancreatic parenchyma without evidence of necrosis.The portal vein and SMV are patent. No aneurysms are identified. The hepatic artery is narrowed but appears patent.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal hypodensity, likely a cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia. Fat-containing umbilical hernia.There is been resolution of ascites, however there is increased mesenteric and omental nodularity.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: Left ovarian cyst with a peripheral calcification measures 4.1 x 3.3 cm (3/100), obscured by ascites on the prior exam but measuring 4.2 x 3.2 cm on the exam from 12/12/2014.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mild degenerative changes of the spine.OTHER: No significant abnormality noted | 1.Findings compatible with resolving acute pancreatitis and new organizing peripancreatic fluid collections. Ascites overall is decreased and there is no evidence of necrosis.2.Complex left ovarian cyst measuring up to 4.2 cm. Further evaluation with ultrasound is recommended.3.Omental and mesenteric nodularity is most likely the sequela of prior pancreatitis. Given complex adnexal cyst, mucinous carcinomatosis may appear similarly but is considered less likely. |
Generate impression based on findings. | 64 year old female with endometrial cancer and metastatic disease to left chest wall. Comparison with prior CT.History nephrectomy. CHEST:LUNGS AND PLEURA: Reference left lower lobe nodule measures 1.0 x 1.3 cm on image 63/105 without interval change. Reference lingula nodule measures 0.7 x 0.7 cm on image 49/105 without change. No new nodules are identified.MEDIASTINUM AND HILA: Superior mediastinal, paratracheal lymph node measures 0.5 x 0 .8 cm, without significant change. Small prevascular node measures 0.6 x 1.1-cm on image 36/199, slightly decreased. Left hilar lymph node measures 1 x 1.2 cm on image 41/199 without change.CHEST WALL: There is again noted a lobulated and partly enhancing mass extending to the skin with associated skin thickening involving the left chest. The previously noted enhancing component is less vascular than on the prior study and appears somewhat smaller, measuring 2.5 x 2.6 cm on image 44/190. Overall mass size is unchanged.There is a small, but enlarging nodule in the inferior left breast on image 57/199.There is a small, but suspicious round lymph node in the right axilla measuring 1.1 x 1.1 cm, new when compared to prior exam.There is again noted a large soft tissue mass involving the left 11th and 12th ribs and eroding the T12 vertebrae with extension into the neural canal. Vertebral body destruction and extension into the canal have progressed, as has the overall size of the mass. Mass invades the left psoas.No change in left internal mammary lymph node.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: There is again noted significant atrophy with deformity of the left kidney due to prior surgery. Some heterogeneity of the nephrogram is again noted.RETROPERITONEUM, LYMPH NODES: Gastrohepatic ligament lymph node measures 0.8 x 0.9 cm on image 85/199, decreased in the interim. Nonenlarged para-aortic lymph node measures approximately 0.4 x 0.7 cm on image 108/199, not significantly changed.BOWEL, MESENTERY: Large ventral hernias containing small bowel and colon.BONES, SOFT TISSUES: There is again noted a large soft tissue mass involving the left 11th and 12th ribs and eroding the T12 vertebrae with extension into the neural canal. Vertebral body destruction and extension into the canal have progressed, as has the overall size of the mass. Mass invades the left psoas.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Large ventral hernias containing small bowel and colon.BONES, SOFT TISSUES: There is again noted a large soft tissue mass involving the left 11th and 12th ribs and eroding the T12 vertebrae with extension into the neural canal. Vertebral body destruction and extension into the canal have progressed, as has the overall size of the mass. Mass invades the left psoas.Small, but enlarging and morphologically abnormal lymph node left groin.OTHER: No significant abnormality noted. | No change in lung nodules.No significant change in mediastinal/hilar adenopathy.Improved retroperitoneal adenopathy.New, abnormal right axillary lymph node.New, left breast nodule.The enhancing component of the left anterior chest wall mass has decreased.Progression of mass involving left ribs, vertebrae and neural canal. |
Generate impression based on findings. | Eructation. Question of delayed gastric emptying. Visually there was significant and progressive gastric emptying up to the early termination point of the exam. Using anterior and posterior geometric means, residual gastric activity at the following postprandial intervals was calculated as follows:30 mins: 78 % of peak activity (normal >70 %)1 hour: 63 % of peak activity (normal 30-90 %) 2 hours: 26 % of peak activity (normal <60 %) 4 hours: Non obtained (normal <10 %) | No specific evidence of gastroparesis though the is study limited due to early termination of exam secondary to patient intolerance. |
Generate impression based on findings. | Osteosarcoma metastatic to the lungs. Staging exam prior to possible metastestectomy.RADIOPHARMACEUTICAL: 14.0 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 124 mg/dL. Today's CT portion grossly demonstrates a left chest tube with residual left pneumothorax and subcutaneous left anterior emphysema. Diffuse although regionally lobular left pleural thickening is also noted. Consolidation is seen the left lung base. Postsurgical changes from bilateral prior wedge resections are noted. A left upper lobe nodule measuring slightly over 1 cm is again noted medially. Large hypodense left renal lesion is likely a cyst. Left leg amputation at the level of the proximal thigh is seen.Today's PET examination demonstrates fairly diffuse mild to moderately hypermetabolic activity throughout much of the left-sided pleural surfaces (SUV max = 3.1). The appearance is more suggestive of benign inflammation than tumor. A punctate mild hypermetabolic left hilar lymph node is also present and most likely inflammatory.The medial left upper lobe nodule demonstrates no significant radiotracer accumulation (SUV max = 1.6).No suspicious FDG avid lesion within the abdomen or pelvis. | 1.No evidence of significantly FDG avid tumor.2.Left upper lobe pulmonary nodule demonstrates only minimal activity. This may represent a benign nodule although weakly FDG avid tumor cannot be entirely excluded.3.Fairly diffuse mild to moderate activity involving the left pleural surfaces considered more likely inflammatory. Again weakly FDG avid tumor cannot be entirely excluded. |
Generate impression based on findings. | Pain in back and shoulders. Metastatic breast cancer. There is marked interval progression of a left proximal humerus lesion. Foci of increased uptake within the T4 vertebral body appear less intense on this examination. There is either increased uptake or a new adjacent focus of uptake in the left L5/S1 region. Otherwise, no new osseous lesions are identified. | Mixed response with worsening left proximal humerus and left L5/S1 lesions. No definite new areas of uptake are identified. |
Generate impression based on findings. | Female; 61 years old. Reason: Cough and dyspnea, smoker, restriction on PFT, history of SLE/Sjogrens. LUNGS AND PLEURA: Scattered calcified and noncalcified pulmonary micronodules, measuring up to 4 mm. No suspicious pulmonary nodules or masses. No pleural effusions or focal areas of consolidation. Scattered areas of nonspecific pleural thickening/scarring. Linear scarring at right lateral lung base. No traction bronchiectasis, honeycombing or other specific evidence of fibrosis.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Calcified mediastinal and hilar lymph nodes compatible with prior granulomatous infection. Scattered aortic calcifications. CHEST WALL: There is right breast skin thickening/nodularity. No axillary lymphadenopathy. Mild multilevel spinal degenerative changes.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Numerous hepatic and splenic granulomata. Cholelithiasis. Partially visualized left adrenal nodule. | 1.Scattered areas of mild pulmonary parenchymal and pleural scarring . No specific evidence of pulmonary fibrosis/ILD consistent with connective tissue disorders.2.Findings compatible with prior granulomatous infection as described above. |
Generate impression based on findings. | 37-year-old male status post bilateral mandibular fracture open reduction internal fixation repair with residual anterior open bite, malocclusion As demonstrated on previous Panorex, there has been interval open reduction internal fixation of bilateral mandibular angle fractures. Hardware is intact. The posterior-most screw on the right appears subjacent to osseous cortex. Fracture fragments are now in near-anatomic alignment. Bony trabecular bridging with periosteal new bone is evident on the left representing healing. Minimal osseous trabeculation across the fracture sites are noted on the right. As before, the TMJ remain well seated. As before, fracture deformity extends through the adjacent molars as well as mandibular canals. The visualized intracranial contents are unremarkable. Paranasal sinuses, mastoid air cells, and middle ear cavities are are clear. | There has been interval open reduction internal fixation of bilateral mandibular angle fractures. Hardware is intact. The posterior-most screw on the right appears subjacent to osseous cortex. Fracture fragments are now in near-anatomic alignment. Bony trabecular bridging with periosteal new bone is evident on the left representing healing. Minimal osseous trabeculation across the fracture sites are noted on the right. |
Generate impression based on findings. | Hyperparathyroidism. Question of parathyroid adenoma. There is physiologic distribution of the radiopharmaceutical. No abnormal focus of activity consistent with an enlarged parathyroid gland is seen. The right thyroid lobe appears to measure 4.1 cm and the left lobe 4.2 cm in length.There is a focus of air posterolateral to the right of the trachea in the lower neck without definitive communication to the trachea or esophagus; this is unchanged from a CT performed on 7/10/2014. | 1. No scintigraphic evidence for parathyroid adenoma.2. Focus of air posterolateral to the trachea. While there is no definitive communication to the trachea or esophagus, this may represent an esophageal diverticulum. If clinically warranted, this may be further evaluated with dedicated imaging. |
Generate impression based on findings. | 72-year-old male with history of metastatic RCC. There is no evidence of acute intracranial hemorrhage. There is mild periventricular and subcortical white matter hypoattenuation compatible with age-indeterminate small vessel ischemic disease. The gray-white differentiation is preserved. There is no midline shift or mass effect. The basal cisterns are intact. The ventricles and sulci are symmetric. The imaged paranasal sinuses and mastoid air cells are clear. There are no lytic osseous lesions. The soft tissues of the scalp are within normal limits. | 1. No evidence of significant mass effect, although we cannot entirely exclude metastatic disease on a noncontrast exam.2. Mild age-indeterminate small vessel ischemic disease.3. No acute intracranial abnormality. |
Generate impression based on findings. | 60 years, Female. Reason: 60F with severe COPD s/p EMR of large cecal lesion (4cm), now with abdominal pain, need to eval for air under diaphragm to r/o microperf History: abdominal pain No evidence of pneumoperitoneum. Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. Rightward curvature of the lumbar spine is noted. | No evidence of pneumoperitoneum. |
Generate impression based on findings. | 7-year-old female with difficulty breathing, feverVIEWS: Chest PA/lateral (two views) 2/23/2015 Left sided aortic arch, cardiac apex and stomach. Narrowing of the subglottic trachea is noted. Peribronchial thickening with no focal pulmonary opacity. Linear streaky opacities in the left lung base likely atelectasis. | Croup with reactive airway disease or bronchiolitis pattern. Likely atelectasis in the lung base. |
Generate impression based on findings. | 57 year old female, evaluate for neoplasm. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Scattered subcentimeter low attenuation hepatic lesions too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right renal simple cyst. Left renal subcentimeter low attenuation lesions too small to characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: A fat-containing small umbilical hernia is present. Mild degenerative changes affect the visualized thoracolumber spine.PELVIS:UTERUS, ADNEXA: The visualized portions of the uterus appear normal. No adnexal masses are identified.BLADDER: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Left hip total arthroplasty device causes significant adjacent beam hardening artifact obscuring adjacent structures. There are scattered geographic areas of relative lucency within the left iliac wing several of which measure fat attenuation and may represent benign intraosseous lipomas or fatty replacement. There is a well-circumscribed low-attenuation lesion within the right pectineus muscle (series 4, image 136). | 1.No specific evidence for metastatic disease.2.Hepatic and liver subcentimeter lesions too small to characterize.3.Low-attenuation lesion within the right adductor musculature, indeterminate and may represent a myxoma but should be further evaluated with dedicated contrast enhanced MRI. |
Generate impression based on findings. | 76 year old woman with history of left lumpectomy for invasive mucinous carcinoma in 2012. 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. Post-operative findings of architectural distortion and surgical clips in the left medial breast are noted. No suspicious masses or microcalcifications are seen in either breast. Benign appearing lymph nodes are projected over both axillae. | 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. | Male 26 years old Reason: hx recurrent dislocations, Bankart, Laterjet History: same, apprehension. Two screws are seen affixing bone graft to the anterior aspect of the glenoid, compatible with stated history of Laterjet procedure. The bone graft appears fused to the underlying glenoid in the axillary view. There may be a mild Hill-Sachs deformity. Glenohumeral alignment is within normal limits. | Postoperative imaging of Laterjet procedure and other findings as described above. |
Generate impression based on findings. | Fell on hip Two views of the right hip and one view of the pelvis demonstrate no fracture. Mild osteoarthritis affects the hips. Chondrocalcinosis is noted at the pubic symphysis. Heterotopic bone formation is seen in the proximal left thigh, appearing similar to prior. | Mild osteoarthritis, with no fracture. |
Generate impression based on findings. | Male 50 years old; Reason: 50Yrs old male patient with marginal zone lymphoma and peripheral neuropathy s/p 6 cycles of bendamustine/rituxan, in need of end of treatment staging History: marginal zone lymphoma CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Small mediastinal lymph nodes, reference precarinal lymph node measuring 1.2 x 0.7 cm, unchanged. 1 cm right hilar lymph node. Prominent internal mammary lymph nodes no longer visualized. Subcentimeter prevascular and juxtaphrenic lymph nodes. Mild to moderate calcified coronary artery disease. Heart borderline in size.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: There is aortobiiliac atherosclerotic disease. Status post resection of previously seen hypermetabolic retroperitoneal/right hemipelvic mass, illdefined right pelvic sidewall soft tissue attenuation that extends to common iliac region, no measurable disease, may merely reflect postsurgical sequela as opposed to residual disease, correlate with concomitant PET imaging from same day to assess for associated hypermetabolic activity. Interval decrease in size of abdominal/retroperitoneal lymph nodes. Reference left iliac lymph node measuring 8 x 6 mm, previously measured 10 x 10 mm. BOWEL, MESENTERY: Aneurysmally dilated small bowel seen at this level with associated postsurgical anastomotic suture material, appearance likely related to the resection. Additional radiodensities seen in mesentery, may reflect calcifications versus iatrogenic material.PELVIS:PROSTATE, SEMINAL VESICLES: Prostatic calcifications. BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Diastases of rectus abdominis muscles containing bowel, no evidence of obstruction. | 1. Postsurgical sequela, minimal illdefined soft tissue attenuation seen in right retroperitoneal/hemipelvic area as above, no measurable disease. Please refer to concomitant PET portion of exam for additional findings. |
Generate impression based on findings. | Male 63 years old Reason: evaluate extent of incisional hernia History: upper midline incisional hernia ABDOMEN:LUNG BASES: Paraseptal emphysema with lingular scarring, unchanged. LIVER, BILIARY TRACT: Hypodense lesions within the liver which are too small to characterize.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Diffuse atherosclerotic calcifications of aorta and its branches. There is an infrarenal abdominal aortic aneurysm status post endovascular repair with stent grafting which is markedly decreased measuring 3.4 by 3.0 cm (series 4, image 76) previously 7 cm. The thrombosed native common iliac arteries are visualized as hyperdense foci in the peri-iliac region.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: There are two discrete fat-containing abdominal ventral hernias. The larger, more superior ventral hernia measures 4.4 x 8.0 cm (series 8025, image 80 and series 4, image 50) with the hernia neck measuring 4.9 cm (series 4, image 57). The smaller, more inferior ventral hernia measures 2.7 x 3.9 cm (series 8025, image 80 and series 4, image 69) with the hernia neck measuring 2.0 cm (series 4, image 69). The hernias do not contain bowel. PELVIS:PROSTATE, SEMINAL VESICLES: Punctate calcifications in the prostate. Surgical clips in the scrotum likely secondary to prior vasectomy.BLADDER: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality noted | 1.Two discrete fat containing abdominal ventral hernias as detailed above.2.Infrarenal abdominal aortic aneurysm status post stent graft repair. |
Generate impression based on findings. | 56 years, Female, Reason: eval for cirrhosis, f/u liver lesion History: hepatitis c. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: There is a lesion within segment 5 again identified measuring 1.1 x 0.8 centimeters (11/53), previously 0.9 x 0.9 cm. This lesion is stable in size since 2009, however there is new peripheral enhancement seen on the arterial phase. Given this lesions long-term stability, neoplasm is considered unlikely and this may represent a hemangioma. Differences in arterial enhancement could potentially be due to variations in arterial phase of contrast. No new suspicious lesions are present.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal hypodensities too small to characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes in the right colon.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Segment 5 lesion has new arterial phase enhancement but is stable in size since 2009. Given this lesions long-term stability, a malignancy would be considered highly unlikely. No suspicious abnormalities in the liver. |
Generate impression based on findings. | 20 year-old male with scoliosis undergoing posterior spinal fixation.VIEWS: Lumbosacral spine AP (one views) 2/23/2015 11:13 Interval placement of pedicle screws from L1 to L3 vertebral bodies bilaterally. Feeding tube tip in the GE junction, side port in the distal esophagus. Curvilinear structure projected in the region of the distal esophagus likely a ray-tec sponge. Esophageal temperature probe tip in the distal esophagus. | 1. Interval placement of pedicle screws from L1 to L3 vertebral body bilaterally.2. Feeding tube tip at the GE junction, side port in the distal esophagus. |
Generate impression based on findings. | Reason: hyperparathyroidism History: hypercalcemia, Selective Venous sampling for Parathyroid hormone levels. There are several nodules present in the soft tissues of the lower neck . Their locations and serial Hounsfield units on dynamic CT or listed below along with some density units of normal structures:Houndsfield units through nodules (0seconds, 25 seconds, 55 seconds, 85 seconds):Right Carotid artery (image # 152 ):: 54.21HU, 459HU, 233HU, 209HURight Jugular vein (image # 152 ):: 56.1HU, 402HU, 248HU, 216HURight submandibular gland (image # 152 ): 59.3HU, 85.0HU, 133HU, 127HURight sternocleidomastoid muscle: (image # 152 ): 75.6HU, 81.2HU, 84.3HU, 78.4HULymph node (image # 108 ): 53.0HU, 85.7HU, 120.4HU, 121.4HURetrosternal nodule image 7x9mm anterior to the pulmonary trunk (image # 435-440 ): 29.6HU, 207HU, 130HU, 116 HU.CT neck:Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland has been removed.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The inferior aspects of the mastoid air cells are clear. The visualized inferior aspects of the maxillary sinuses are clearThe parotid and the submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. There degenerative changes present with endplate and uncovertebral osteophytes at the C5-6 where there is a narrowing of the neural foramina and mild narrowing of the spinal canal.Parathyroid sampling:Intraprocedural images demonstrate the location of venous sampling.Reported PTH, Intact values (REF 15-75 pg/mL):FEMORAL VEIN: 123SUPERIOR VENA CAVA: 136INNOMINATE VEIN JUNCTION: 206LEFT INNOMINATE VEIN: 122LEFT INTERNAL JUGULAR VEIN, LOWER: 131LEFT INTERNAL JUGULAR VEIN,MID: 117LEFT INTERNAL JUGULAR VEIN, UPPER: 118RIGHT INTERNAL JUGULAR VEIN, LOWER: 123RIGHT INTERNAL JUGULAR VEIN, MID: 116RIGHT INTERNAL JUGULAR VEIN, UPPER: 121 | 1.There is a 9mm anterior mediastinal nodule located behind the sternum and towards the left, anterior to the pulmonary trunk which is suspicious for a parathyroid adenoma based on contrast uptake on dynamic CT.2.Parathyroid venous sampling suggest highest level at the innominate vein junction which corresponds with the above described lesion.3.Degenerative changes of the cervical spine are worse at C5-6 as detailed above. |
Generate impression based on findings. | Follicular lymphoma of the small intestines following resection. Staging exam.RADIOPHARMACEUTICAL: 10.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 88 mg/dL. Today's CT portion grossly demonstrates a postsurgical appearance to the upper abdomen. Hypodense left adnexal lesion is likely a cyst.Today's PET examination demonstrates no suspicious FDG avid lesion to indicate tumor activity currently.A mild region of increased activity in the distal esophagus is most typically benign inflammation/physiologic. Left adnexal mild focus is also more likely benign in a premenopausal female. Linear subcutaneous activity in the left abdomen is consistent with post surgical inflammation. | No FDG avid tumor currently identified in the neck, chest, abdomen or pelvis. |
Generate impression based on findings. | Female 69 years old; Reason: Severe DJD noted in hip x-rays done 12/2014. Evaluate interval change. History: severe L hip pain, known OA L-SPINE: The bones are demineralized. Severe facet osteoarthropathy affects the lower lumbar spine, with grade 1 anterolisthesis of L5 on S1. There is hypertrophy of the spinous processes with associated degenerative changes. The vertebral body heights are maintained. The disk spaces are preserved. Moderate degenerative changes affect the visualized lower thoracic spine. Atherosclerotic calcification of the abdominal aorta is noted.LEFT HIP: Mild osteoarthritis affects the left hip. Mild enthesopathic changes are noted along the greater trochanter with ossific foci above the greater trochanter, appearing similar to that seen on the prior study.PELVIS: Three views of the pelvis demonstrate the aforementioned mild left hip osteoarthritis. Mild osteoarthritis affects the right hip. Vascular calcification is noted in the pelvis and upper thighs bilaterally. | 1. Mild degenerative changes of the hips. 2. Severe facet osteoarthropathy of the lower lumbar spine. |
Generate impression based on findings. | Male 73 years old Reason: pain - evaluate for bone spurs History: pain. Two views of the left elbow show small enthesophytes along the posterior aspect of the olecranon at the triceps insertion of questionable significance. Alignment is within normal limits. We see no joint effusion.We have two views of the right elbow. The right elbow appears normal for patient's age. | Small enthesophytes of the left olecranon of questionable significance. The elbows otherwise appear normal for age. |
Generate impression based on findings. | Male 64 years old Reason: "eval fx RF" History: same. There is a spiral/oblique fracture of the proximal mid-diaphysis of the fourth metacarpal with mild volar angulation of the distal fracture fragment. Mild osteoarthritic changes affect the hand. There is an ossicle adjacent to the radial styloid which may reflect old trauma. | Fourth metacarpal fracture as above. |
Generate impression based on findings. | Lymphoplasmacytic lymphoma transformed to diffuse large B cell status post 6 cycles of chemotherapy with near complete remission subsequently suffered left-sided vision loss and found to have leptomeningeal recurrence. Restaging exam.RADIOPHARMACEUTICAL: 10.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 83 mg/dL. Today's CT portion of the neck demonstrates chronic-appearing pansinusitis. Please see diagnostic CT reports for details of the chest, abdomen, and pelvis.Today's PET examination demonstrates no suspicious FDG avid lesion to indicate tumor activity currently in the neck, chest, abdomen or pelvis. Near complete resolution of previous bilateral lung base activity with residual slight activity on the left is consistent with resolving inflammation. Diffuse activity throughout muscle groups surrounding the right shoulder also consistent with benign physiologic or inflammatory activity. | 1.No FDG avid tumor currently identified in the neck, chest, abdomen or pelvis.Diagnostic CTs of the chest, abdomen, and pelvis also performed at today's visit will be reported separately. |
Generate impression based on findings. | Male 46 years old Reason: right foot pain History: x-ray with attention to dorsal surface to arch . There may be mild soft tissue swelling along the dorsal aspect of the foot, but this is equivocal. We see no fracture or malalignment. Note is made of an os peroneum, a normal variant. | Possible mild soft tissue swelling. Otherwise, no specific findings to account for patient's pain. |
Generate impression based on findings. | 20 old male with scoliosis undergoing post posterior spinal fusion. VIEWS: Lumbosacral spine AP and lateral (two views) 2/23/2015 12:40 Redemonstration of pedicle screws from L1 to L3 vertebral bodies bilaterally with interval placement of additional pedicle screws in T11, T12 and L4 vertebral bodies bilaterally. Feeding tube tip in the GE junction, side port in the distal esophagus. Previously noted curvilinear structure projected in the region of the distal esophagus likely ray-tec sponge is no longer seen. | 1. Pedicle screws from T11-L4 vertebral bodies bilaterally.2. Feeding tube tip at the GE junction, side port in the distal esophagus. |
Generate impression based on findings. | 14-year-old female with concern for aspirationEXAMINATION: Oropharyngeal motility study 2/23/1514:57 Julie Ecclestone (pager 8293), speech and language therapist, supervised the examination.1 minute 30 seconds of fluoroscopy was used.Delayed swallow without penetration or aspiration with solids, purée and nectar administration. Premature spillage into the hypopharynx was noted with thin liquids without aspiration. | Shallow penetration with thin liquids. No evidence of aspiration. Please see the speech and language therapist's report for feeding recommendations. |
Generate impression based on findings. | Male 20 years old; Reason: evaluating for fracture History: pt with acute injury yesterday playing soccer, now unable to bear wt w/o pain, pain is greatest along the medial aspect of foot, instep, metatarsal area. Three views of the right foot demonstrate no fracture or dislocation. No specific findings are identified to account for the patient's pain. | No specific findings to account for the patient's pain. |
Generate impression based on findings. | Metastatic adenocarcinoma of the gastroesophageal junction status post chemotherapy, last February 2015. Restaging exam.RADIOPHARMACEUTICAL: 7.9 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 101 mg/dL. Today's CT portion grossly demonstrates left subpleural scattered pulmonary parenchymal foci. Several borderline enlarged lymph nodes are seen in the retrocrural, porta hepatic, and anterior mesenteric locations. Extensive atherosclerotic including coronary arterial calcifications are noted.Today's PET examination demonstrates a small focus of moderately increased activity in the retrocrural region just inferior to the gastroesophageal junction. This activity has increased somewhat from the previous exam (SUV max = 2.6 previously, = 4.6 currently) and is of some suspicion for disease progression.Slightly more inferiorly in the porta hepatic region there is additional small but moderately hypermetabolic lymph nodes which are more prominent than previous (SUV max = 4.2) and are also of some suspicion for disease progression.A small soft tissue density deposit in the anterior abdominal mesentery is also mild to moderately FDG avid and slightly more prominent currently (SUV max = 3.3), again of equivocal suspicion for tumor progression.In the right cerebellar hemisphere laterally there is a suggestion of subtle increased and decreased activity which was not seen on the previous exams. This is incompletely visualized but could represent metastatic disease or infarct.No suspicious FDG avid lesions identified elsewhere. Previous colonic foci are no longer evident and more likely inflammatory. | 1.Multiple small mild to moderately hypermetabolic abdominal lymph nodes have progressed from previous and are of some suspicion for disease progression although somewhat equivocal. Attention to these regions on follow-up exam can be made.2.Possible new right cerebellar lesion could represent metastasis or infarct although is incompletely evaluated. Correlate clinically as to the need for further evaluation with dedicated brain CT or MR. |
Generate impression based on findings. | Elbow pain Four views of the left elbow demonstrate a silastic radial head, which appears to be undergoing mild fragmentation. Mild osteoarthritis affects the elbow. | Silastic radial head and mild osteoarthritis, as described above. |
Generate impression based on findings. | Female 78 years old. Pain to anterior upper tibia right after a fall 4 months ago ANKLE: The bones are demineralized. We see no fracture. Arterial calcifications are noted in the soft tissues. Small plantar and posterior calcaneal spurs are noted and may be of no clinical significance.TIBIA/FIBULA: The bones are demineralized. We see no fracture, particularly of the proximal tibia. | No fracture evident. |
Generate impression based on findings. | Male 47 years old Reason: post-op alignment History: post-op ORIF. Orthopedic pins affix a comminuted fracture of the proximal phalanx of the ring finger in near anatomic alignment. Slight radial angulation of the distal fracture fragment appearing similar to that seen on the prior study. The fracture remains visible and we see no callus formation at this time. Additionally, two orthopedic pins affix the remaining middle and proximal phalanges of the fifth finger in anatomic alignment,. Small fragments in the soft tissues around the middle phalanx of the fifth finger may represent bone graft material and/or residual fracture fragments.A hairline lucency within the cortex of the radial aspect of the proximal phalanx of the middle finger is noted, which we suspect is artifactual rather than representing acute fracture. Overall the bones are demineralized, similar to the prior study. | Orthopedic fixation of fourth and fifth finger fractures appearing similar to the prior study. |
Generate impression based on findings. | Male 35 years old; Reason: Evaluate right metacarpal, out of cast Two views of the right hand demonstrate a plate and screw device affixing the fracture through the distal diaphysis of the fifth metacarpal in near-anatomic alignment. We see no radiographic evidence of hardware complication. The fracture line remains visible; however, callus formation adjacent to the fracture indicates some interval healing. | Fixation of healing fifth metacarpal fracture. |
Generate impression based on findings. | 38-year-old male with abdominal tenderness and distention, evaluate for intra-abdominal infection. ABDOMEN:LUNG BASES: Bilateral small pleural effusions with associated basilar compressive atelectasis, increased from prior. Multiple ill-defined solid nodules with surrounding groundglass opacities bilaterally which are increased in size from prior and are most consistent with an atypical infection, specifically fungal.LIVER, BILIARY TRACT: Low-attenuation lesion in segment 5 (series 12, image 56) similar to prior. There is gallbladder mucosal hyperenhancement and fluid surrounding the gallbladder. SPLEEN: Splenomegaly appearing similar to prior.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of bowel obstruction. Mild small bowel wall thickening which is nonspecific but may be related to ascites. There is diffuse colonic submucosal edema and wall thickening compatible with pancolitis. BONES, SOFT TISSUES: New anasarca.OTHER: New moderate abdominopelvic ascites. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: The bladder is distended. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No evidence of bowel obstruction. Mild small bowel wall thickening which is nonspecific but may be related to ascites. There is diffuse colonic submucosal edema and wall thickening compatible with pancolitis. Rectal tube in place. BONES, SOFT TISSUES: New anasarca.OTHER: New moderate abdominopelvic ascites. | 1.Ill-defined pulmonary nodules suspicious for fungal infection, increased from prior. Bilateral small pleural effusions, increased from prior. Please see chest CT from same day for full details regarding chest.2.New abdominopelvic ascites and anasarca.3.Fluid surrounding gallbladder, cannot exclude acute cholecystitis. Recommend ultrasound for further evaluation.4.New pancolitis, favor infectious etiology in this neutropenic patient, findings may be seen in setting of pseudomembranous colitis. 5.Low-attenuation hepatic lesion incompletely characterized. Ultrasound may provide additional information. In the appropriate clinical setting, could perform dedicated contrast enhanced imaging to ensure stability and for more definitive characterization after acute illness has resolved. Findings discussed with Dr. Berg at 3:30 p.m. on 2/23/2015. |
Generate impression based on findings. | 84 years, Female. Reason: assess stool burden, assess for bowel dilation History: abd distension, diarrhea Scattered loops of air distended small and large bowel in a nonobstructive bowel gas pattern. Less than average stool burden. | Nonobstructive bowel gas pattern. Less than average stool burden. |
Generate impression based on findings. | Four month old male with NJ tube. Evaluate placement.VIEW: Abdomen AP (one view) 2/23/2015 15:21 NJ tube coursing to the proximal portion of the second duodenum with tip coiled likely in the duodenal bulb. Dilated bowel loops with no definite evidence of obstruction. | 1. NJ tube tip coiled likely in the duodenal bulb.2. Dilated bowel loops with no definite evidence of obstruction. |
Generate impression based on findings. | Severe ILD pattern consistent with langerhans cell histiocytosis. Evaluate for myeloma or langerhans cell histiocytosis. No abnormal osseous foci are identified to indicate metastatic disease.Foci of uptake within the cervical spine likely represents degenerative change. Increased uptake within the sternum and manubrium likely related to prior median sternotomy. Posterior left 10th rib deformity presumably post-traumatic. | No evidence of bone metastases. |
Generate impression based on findings. | Female 79 years old Reason: fracture History: pain. We have 3 views of the left hand. The bones appear demineralized. We see no fracture. There is osteoarthritis of the first carpometacarpal joint and mild osteoarthritis of the interphalangeal joints. | Osteoarthritis without fracture evident. |
Generate impression based on findings. | 55 years, Female. Midline surgical suture material is noted many of which appear fractured. No herniation of bowel loops are noted on the lateral view. Metallic radiodensity projects over the anterior pelvis only seen on lateral view. On previous CT scout radiograph, the same density is noted in the soft tissues of the upper left thigh, like a bullet. Nonobstructive bowel gas pattern. Greater than average stool burden. | Greater than average stool burden. Bullet in the soft tissues of the left upper thigh. |
Generate impression based on findings. | 78 years, Female, Reason: Gallbladder/cholangiocarcinoma - restaging prior to starting therapy. History: back pain. CHEST:LUNGS AND PLEURA: Scattered nonspecific micronodules. No suspicious nodules or masses.MEDIASTINUM AND HILA: Left thyroid nodule. Right chest port tip terminates at the cavoatrial junction. Severe atherosclerotic calcifications of the aorta and its branches. Moderate to severe coronary artery calcifications.CHEST WALL: Left breast mass containing calcification. Right chest wall port. No axillary lymphadenopathy. Median sternotomy wires.ABDOMEN:LIVER, BILIARY TRACT: There is a multiloculated enhancing mass within the gallbladder measuring 5.8 x 3.7 x 5.3 cm (3/94, 8060/30 which invades the adjacent liver parenchyma. There is invasion to the hepatic hilum and Klatskin with involvement of the right and left intrahepatic bile ducts. There is invasion of the common bile duct which is obstructed proximally (8060/34) with moderate intrahepatic biliary ductal dilatation. The hepatic artery is also encased. Tumor extends inferiorly invading the adjacent colon at the hepatic flexure.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: 7 mm stone in the proximal left ureter with dilatation of the proximal ureter. No significant hydronephrosis on the left.RETROPERITONEUM, LYMPH NODES: Mild retroperitoneal lymphadenopathy with enlarged left para-aortic node measuring 1.5 x 1.0 cm (3/102).BOWEL, MESENTERY: Invasion of colon at the hepatic flexure. No evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: FemaleUTERUS, 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: Mild degenerative changes of the spine with an inferior end plate deformity at L2.OTHER: No significant abnormality noted. | 1.Gallbladder neoplasm with invasion of liver, hepatic hilum and adjacent colon. There is invasion and obstruction of the common bile duct with moderate intrahepatic biliary ductal dilatation.2.Mild retroperitoneal lymphadenopathy.3.Obstructing left proximal ureteral stone.4.Left breast soft tissue lesion with calcification is nonspecific. Correlation with prior mammograms is recommended. |
Generate impression based on findings. | New pain in thoracic spine and left posterior ribs. History of breast cancer. THORACIC SPINE: The bones appear demineralized. Mild multi-level degenerative disk disease affects the thoracic spine. No focal lesions are seen to suggest metastatic disease.RIBS: No specific findings are identified to account for the patient's rib pain. Surgical clips are noted in the left axilla and chest wall. | Mild degenerative disk disease of the thoracic spine. No specific findings to account for the patient's pain. |
Generate impression based on findings. | 16 year-old female with tenderness to palpation along the distal radiusVIEWS: Left wrist PA, oblique, and lateral (3 views), right hand PA, right ring finger oblique, lateral (3 views) 2/23/15 15:12 Wrist: Alignment is anatomic. The distal radius, ulna and carpal bones are intact without fracture or malalignment.Hand/fourth digit: Mild soft tissue swelling along the distal fourth digit and apparent soft tissue defect dorsal to the PIP joint without underlying osseous abnormality. Alignment is anatomic. | No fracture or dislocation. Apparent soft tissue defect dorsal to the PIP joint. |
Generate impression based on findings. | Female 71 years old Reason: Evaluate for possible fracture History: Pain distal left fibula s/p fall 3 months ago. Three views of the ankle show no fracture or malalignment.Two views of the left fibula and tibia show no fracture or malalignment. Calcific foci within the distal tibial metadiaphysis may represent an enchondroma or chronic bone infarction. Mild osteoarthritis affects the knee. | No fracture evident. Other findings as described above. |
Generate impression based on findings. | Male 38 years old Reason: eval fracture healing History: s/p ORIF. Three views of the left middle finger show 3 screws affixing an oblique fracture of the proximal phalanx in near anatomic alignment. The fracture line is less distinct on the current study than on the prior study indicating some interval healing.Three views of the left ring finger show 3 screws affixing an oblique fracture of the proximal phalanx in near anatomic alignment. The fracture line is less distinct on the current study than on the prior study indicating some interval healing. | Orthopedic fixation of healing left middle and ring finger fractures. |
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