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Generate impression based on findings. | 38 year old woman with history of diabetic mastopathy. Patient gives history of waxing and waning palpable mass in the lateral left breast. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is extremely dense, which lowers the sensitivity of mammography, unchanged in pattern and distribution. There is no dominant mass, suspicious microcalcifications, or areas of architectural distortion in either breast. Benign appearing lymph nodes are projected over the right axilla.SONOGRAPHIC | Decrease in size of mixed echogenicity area in the left breast, benign in appearance. 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. | Lung cancer metastatic to bone status post chemotherapy, last given February 2015. Restaging exam.RADIOPHARMACEUTICAL: 9.8 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 200 mg/dL. Today's CT portion grossly demonstrates left frontal craniotomy defect. Air-fluid levels in both maxillary sinuses suggestive of acute sinusitis. Small bilateral upper lobe ground glass pulmonary nodules grossly unchanged within the limits of low-dose CT technique. Extensive atherosclerotic including coronary arterial calcifications. Cholecystectomy clips are noted. A destructive left ischial lesion again present.Today's PET examination demonstrates the left ischial lesion to be again markedly metabolically active although slightly decreased in size and metabolic activity from previous (SUV max = 11.9 [adjusted to account for differences in background SUV] previously, = 8.8 currently).No additional suspicious hypermetabolic lesion is identified. The ground glass pulmonary nodules are again not FDG avid but nonetheless suspicious for indolent synchronous lung cancer. | 1.Left ischial osseous metastasis remains significantly metabolically active although slightly improved from previous.2.No new or additional FDG avid metastasis.3.Bilateral upper lobe ground glass pulmonary nodules are again not FDG avid but remain suspicious for indolent synchronous lung cancer.4.Acute appearing bilateral maxillary sinusitis. |
Generate impression based on findings. | Total elbow arthroplasty LEFT WRIST: The bones are demineralized. Three views of the left wrist demonstrate a plate and screw device affixing a healed distal radius fracture in near-anatomic alignment. We see no radiographic evidence of hardware complication. Deformity of the distal ulnar diaphysis indicates an old healed fracture. Deformity of the first metacarpal indicates an old healed fracture. Mild osteoarthritis affects the wrist, appearing similar to that seen on the prior study.ELBOW: Four views of the left elbow demonstrate hardware components of a total elbow arthroplasty device situated in near-anatomic alignment. We see no radiographic evidence of hardware complication.SHOULDER: Three views of the left shoulder demonstrate deformity of the humeral head and neck indicating an old healed fracture. The bones are demineralized. The glenohumeral joint alignment is within normal limits. Granulomas are noted in the visualized lung. | Healed wrist and shoulder fractures and total elbow arthroplasty device, as described above. |
Generate impression based on findings. | Male; 38 years old. Reason: PE History: tachypnea, hypoxia. PULMONARY ARTERIES: No evidence of acute pulmonary embolism. Normal main pulmonary trunk diameter.LUNGS AND PLEURA: New moderate bilateral pleural effusions with overlying compressive atelectasis. Multiple ill-defined solid nodules in both lungs with surrounding ground glass opacity have increased in size since the prior CT. The largest nodule measures 16 mm, previously 12 mm (series 11, image 43). Imaging appearance is consistent with worsening atypical infection, likely fungal infection.MEDIASTINUM AND HILA: Normal heart size with moderate pericardial effusion demonstrating interval increase. No coronary calcifications. No significant mediastinal or hilar lymphadenopathy.CHEST WALL: Left PICC tip terminates in right atrium. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Splenomegaly. Perihepatic and perisplenic ascites, increased since the prior study with new mesenteric free fluid. Hypodense lesion seen in right hepatic lobe on prior study is not well visualized. Nonspecific moderately enlarged gastrohepatic ligament node is again noted. | 1.No evidence of acute pulmonary embolism.2.Interval increase in size of multifocal solid lung nodules, consistent with worsening fungal infection.3.New bilateral pleural effusions and increased pericardial effusion and ascites.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 40-day-old male with hypoxia, continued O2 requirements. Evaluate for interstitial and/or parenchymal lung disease. LUNGS AND PLEURA: Diffuse bilateral ground-glass opacities are present. Multiple very small round lucencies are noted. No air trapping is seen. No pleural effusion or pneumothorax. MEDIASTINUM AND HILA: Normal sized heart with no pericardial effusion. No axillary, mediastinal or hilar lymphadenopathy.CHEST WALL: No osseous pathology is noted. UPPER ABDOMEN: Normal in appearance. | Diffuse bilateral ground-glass opacities which may represent congenital surfactant deficiency or pulmonary interstitial glycogenosis. Neuroendocrine cell hyperplasia in infancy is less likely given that there is no air trapping. |
Generate impression based on findings. | Restaging marginal zone lymphoma status post chemotherapy, last January 2015.RADIOPHARMACEUTICAL: 11.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 108 mg/dL. Today's CT portion of the neck demonstrates no significant pathology. Please see diagnostic CT reports for details of the chest, abdomen, and pelvis.Today's PET examination demonstrates complete interval resolution of previous extensive hypermetabolic tumor in the chest, abdomen and pelvis without suspicious FDG avid lesion to indicate tumor activity currently. | 1.Complete interval resolution of previous extensive hypermetabolic tumor without FDG avid tumor currently 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 43 years old; Reason: acute pancreatitis, pseudocyst with drain in place, not draining, evaluate fluid collections and pancreas History: Acute pancreatitis, pseudocyst ABDOMEN:LUNGS BASES: Small left pleural effusion with underlying atelectasis.LIVER, BILIARY TRACT, PANCREAS: Intra/peripancreatic fluid collections with largest lobulated dominant collection in upper abdomen and intimately associated with left hepatic lobe, contains ventral approach percutaneous drainage catheter, collection measures approximately 19.2 x 8.4 cm, image 31 series 3, tiny gaseous foci may be iatrogenic in etiology. Additional much smaller loculated fluid seen, for example, in left ventral upper abdomen measuring 4.8 x 2.3 cm, may represent extension of aforementioned dominant collection versus a separate collection. Small collection/loculated fluid also suggested along lesser curvature of stomach and also seen in region of pancreatic head/neck, latter measuring 6.2 x 3.2 cm, image 66 series 3. Inferior to the pancreas is a smaller collection surrounding the SMA and SMV vessels, measuring 5.2 x 4.2 cm, image 81 series 3. Remainder of pancreatic parenchymal shows enhancement within normal limits. Small perihepatic, pericholecystic and pelvic ascites.Left portal vein not well seen with collateral vessel formation, likely reflecting left portal venous thrombosis, splenic vein thrombosis with multiple left upper quadrant, perisplenic and gastroepiploic varices seen. Marked luminal narrowing of SMV. Patent hepatic and splenic arteries.Heterogeneous hepatic segment 7 predominately hypoattenuating lesion measuring 2.9 x 2.4 cm on image 32 series 3, discontinuous peripheral nodular enhancement present, favoring a hemangioma. Another hepatic dome hypoattenuating lesion, too small to characterize, image 18 series 3, but another hemangioma favored based on apparent interrupted peripheral nodular enhancement best seen in coronal plane, image 73. Additional ill-defined hepatic parenchymal heterogeneity, particularly around gallbladder fossa, nonspecific. SPLEEN: Splenomegaly, measuring up to 16 cm in longitudinal dimension.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric renal parenchymal enhancement.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gastrojejunal enteric tube seen with tip beyond ligament of Treitz in left upper quadrant.PELVIS:PROSTATE/SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Small abdominopelvic ascites. | Pancreatic fluid collections as above. |
Generate impression based on findings. | Female 66 years old; Reason: Evaluate left 4th toe fracture There is a nondisplaced fracture through the proximal phalanx of the fourth toe, seen only on the oblique view.Deformity at the neck of the proximal phalanx of the second toe presumably represents a chronic fracture as this appears similar to the prior study. | Nondisplaced fracture of the fourth toe, as described above. |
Generate impression based on findings. | No CT evidence of acute large territorial ischemia. Moderate to severe subcortical and periventricular hypoattenuation consistent with small vessel ischemic disease of indeterminate age. Scattered prior cortical strokes are noted. Moderate prominence of the ventricles and sulci consistent with age-related volume loss. There are no masses, mass effect or midline shift. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are clear. | 1.No CT evidence of large acute territorial ischemia. If there is high clinical concern for acute ischemia, further evaluation with MR is recommended.2.Severe small vessel ischemic disease of indeterminate age and evidence of prior remote scattered cortical strokes. |
Generate impression based on findings. | Reason: s/p LVAD, wound debridement for chest infection w/ ecoli , Now ecoli bacteremia. Eval for fluid collection History: ecoli bacteremia and fever CHEST:LUNGS AND PLEURA: Persistent bilateral pleural effusions. Stable ground glass, interstitial and airspace opacity in the lingula which may be due to aspirate or infection. Similar but less severe findings in the right middle lobe are also stable.MEDIASTINUM AND HILA: Status post CABG, LVAD. Trace pericardial fluid versus thickening with stable minimal inflammatory changes in the anterior mediastinum. Multiple borderline lymph nodes are unchanged. Cardiomegaly. Mildly enlarged central pulmonary arteries suggestive of pulmonary hypertension.CHEST WALL: LVAD driveline appears intact without soft tissue fluid collection or abscess.ABDOMEN: Absence of IV and 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: Nonobstructing right renal calculus. Stable hypodense lesion in the upper pole of the right kidney likely represents a simple cyst.PANCREAS: The pancreas is nearly completely obscured by beam hardening artifact.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta and its branches. Ectatic infrarenal abdominal aorta with fusiform shape stable.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: LVAD present but no significant associated abscess is seen.OTHER: No significant abnormality noted. | Persistent bilateral pleural effusions. Stable ground glass, interstitial and airspace opacity in the lingula which may be due to aspirate or infection. Similar but less severe findings in the right middle lobe are also stable. No evidence of abscess as clinically queried. |
Generate impression based on findings. | One day old male full-term neonate with chest tube in place, history of pneumothorax now with hypocarbia. No interval change pneumothorax or other acute intrapulmonary process.VIEW: Chest AP (one view) 2/23/20151 5:50 Right-sided chest tube has been retracted with tip outside the lung in the subcutaneous soft tissues of the right chest wall. Feeding tube tip in the stomach. Umbilical venous catheter tip in the right atrium.Cardiothymic is normal. No focal pulmonary opacity. Persistent small right pneumothorax. No left pneumothorax. No pleural effusion. | 1. Persistent small right pneumothorax not significantly changed.2. Right chest wall tube tip has been retracted and is located outside the lung. |
Generate impression based on findings. | 70-year-old female with history of foreign body in colon, assess for passage. Within the limits of a non IV contrast enhanced examination which limits the ability to evaluate solid parenchymal organs and vascular structures, the following observations can be made: ABDOMEN:LUNG BASES: Dependent atelectasis and new bilateral small pleural effusions.LIVER, BILIARY TRACT: Cholelithiasis without evidence of acute cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Moderate atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. Above average stool burden in the colon and rectum. No intraperitoneal free air or free fluid. There is a 1.3-cm nonspecific density within the sigmoid colon (series 3, image 77) which may represent the previously seen nonspecific 2.0-cm density within the transverse colon.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Small foci of gas within the bladder. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic focus within a left ileum likely benign bone island. OTHER: No significant abnormality noted | 1.New bilateral small pleural effusions.2.There is a 1.3-cm nonspecific density within the lumen of the sigmoid colon which may represent interval transit of previously seen nonspecific density in the transverse colon.3.Cholelithiasis. 4.Small foci of gas within the bladder which may be related to instrumentation, correlate clinically. |
Generate impression based on findings. | Male 14 years old Reason: post-operative s/p K-wire placement History: post-op s/p K wire placement. The K wires seen on the previous study affixing a fracture of the first metacarpal and proximal phalanx have been removed. The fracture lines remain visible, although are less distinct on the current study than on the prior study, suggesting some interval healing. Again seen are multiple metallic densities in the surrounding soft tissues presumably reflecting ballistic fragments. Also again seen are postoperative changes of an amputation of the fifth finger through the proximal interphalangeal joint. | Healing fractures and postoperative changes as described above. |
Generate impression based on findings. | 18-month-old female with history of trauma. Evaluate for intracranial hemorrhage or fracture. There is no evidence of acute intracranial hemorrhage or mass. The grey-white matter differentiation appears to be intact. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. | No evidence of acute intracranial hemorrhage or calvarial fracture. |
Generate impression based on findings. | Male, 50 years old, history of dentigerous cyst with maxillary sinus fistula. A periapical cyst is again seen associated with the left second maxillary molar projecting superiorly into the left maxillary sinus. This lesion demonstrates a thickened sclerotic wall which is irregular and discontinuous in areas, particularly laterally. The overall size of this lesion has not significantly changed. On the prior exam, the cyst contained an air fluid level, but on the present study, it is fully opacified by either soft tissue or fluid.The frontal sinuses and frontoethmoidal recesses are clear. The sphenoid sinuses are clear. The sphenoethmoidal recesses are not well visualized but are probably not significantly obstructed. The right maxillary sinus is clear and the right maxillary outflow pathway is unobstructed. The left maxillary sinus contains the above mentioned cyst and a small amount of additional mucosal thickening or secretions. The left maxillary outflow pathway is probably patent.The nasal septum is intact. The nasal cavity is clear. The turbinates are unremarkable. | A periapical cyst associated with the left second maxillary molar has not significantly changed in size. While on the prior examination, the cyst contained an air fluid level, it is completely opacified on the present study. There remain some areas of discontinuity of the lateral aspect of the cyst wall which imply fistulous communication with the oral cavity. |
Generate impression based on findings. | 76 years, Female, Reason: Assess for treatment response for small cell ung cancer History: None. ABDOMEN:LUNG BASES: Pleural-based right lower lobe nodule is unchanged in size measuring 1.7 x 1.0 cm (3/9), previously 1.7 x 1.2 cm.LIVER, BILIARY TRACT: Cholelithiasis without evidence of cholecystitis.SPLEEN: No significant abnormality notedPANCREAS: Fluid collection adjacent to the pancreatic tail as described below.ADRENAL GLANDS: Right adrenal nodule is stable. Left adrenal gland is not definitively identified.There is a fluid collection in the region of the left adrenal, posterior to the tail the pancreas which measures 7.3 x 4.0 cm (4/54), previously 7.9 x 4.2 cm. A small amount of enhancing tissue along the medial aspect of the collection, adjacent to the aorta is of uncertain etiology but appears similar to the prior exam. A smaller collection more posteriorly is unchanged.KIDNEYS, URETERS: Bilateral renal cysts.RETROPERITONEUM, LYMPH NODES: IVC filter is unchanged. Severe atherosclerotic calcifications of the aorta and its branches with multiple areas of mural thrombus are unchanged. Thrombus and IVC filter is not well seen on this study.BOWEL, MESENTERY: Mild hiatal hernia. Diverticulosis without evidence of diverticulitis. Resolution of descending colon bowel wall thickening seen previously.BONES, SOFT TISSUES: Air within the subcutaneous tissues of the abdomen and pelvis is likely related to prior injections.OTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: Atrophic/surgically absent uterus.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: T11 the superior endplate depression is stable.OTHER: No significant abnormality noted | 1.Evolving hematoma abutting the pancreatic tail is decreased in size. Adjacent enhancing tissue is unchanged.2.Right lower lobe nodule is stable.3.Resolution of bowel wall thickening in the descending colon.4.Stable right adrenal nodule. |
Generate impression based on findings. | Rule out FAI, CAM The patient initially underwent CT scanning of the hip on February 13. However, due to technologist error, the knees and pelvis were not scanned. The patient therefore was asked to return for additional scanning on February 23.MEASUREMENTS: CAM location : Three o'clock anteriorAlpha angle : 55 degreesCoronal center-edge angle : 36 degrees (corrected for pelvic obliquity)Sagittal center-edge angle : 67 degrees (in true sagittal plane, to anterior edge of the acetabulum)Femoral neck-shaft angle : 129 degreesAcetabular version (1 o’clock) : 10 degrees of retroversion (corrected for pelvic obliquity)Acetabular version (2 o’clock) : 7 degrees of retroversion (corrected for pelvic obliquity)Acetabular version (3 o’clock) : 13 degrees of anteversion (corrected for pelvic obliquity)Femoral version angle (+anteverted, -retroverted) : 12 degrees of anteversionMcKibbin index : 25 degreesAIIS width : Approximately 1 cmDistal base of AIIS to acetabular rim : Approximately 3 mm | Cranial acetabular retroversion, borderline CAM deformity and other measurements as described above. |
Generate impression based on findings. | Baseline pre-transplant. Status post chemotherapy. The patient’s weight of 91 kg and height of 193 cm were used for all calculations.Raw GFR = 206 mL/minBSA = 2.219 m2Estimated GFR/m2 = 93 mL/min/m2Estimated GFR/m2 * 1.73 m2 (average adult BSA) = 160 mL/min (adult GFR equivalent) | GFR measurements as above. |
Generate impression based on findings. | Male 72 years old Reason: renal cancer History: renal cancer. Per surgical pathology from outside hospital, FNA of left lower lobe mass positive for renal cell carcinoma, clear-cell type. CHEST:LUNGS AND PLEURA: Lobulated, slightly heterogeneous lesion in the superior segment of the left lower lobe measuring 2.8 x 2.6 cm (series 3, image 39) which is consistent with metastasis. Additional nonspecific micronodule in the left upper lobe (series 5, image 31). Fibrotic changes in the dependent portion of the left upper lobe. Postsurgical changes in the right upper lobe lobe with associated suture material.MEDIASTINUM AND HILA: Mild mediastinal lymphadenopathy. Reference subcarinal lymph node measures 1.6 x 0.9 cm (series 3, image 51). Heart size is normal without pericardial effusion. Severe coronary artery calcifications.CHEST WALL: Status post median sternotomy.ABDOMEN:LIVER, BILIARY TRACT: Segment two hypodense lesion likely representing a hepatic cyst.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Left adrenal nodule measures 3.1 x 2.0 cm (series 3, image 103) which is suspicious for metastatic disease.KIDNEYS, URETERS: Bilateral, heterogeneously enhancing renal lesions compatible with renal cell carcinoma. Dominant left upper pole lesion measures 6.5 x 6.5 cm (series 3, image 112). Dominant right renal lesion measures 9.3 x 5.1 cm (series 3, image 130). Additional, much smaller renal lesions are suspicious for malignancy. Intrarenal right renal venous intraluminal filling defect (series 3, image 132) with intraluminal heterogeneity at the junction of the right renal vein and IVC (series 3, image 118) suspicious for thrombosis. Nonobstructive right nephrolithiasis.RETROPERITONEUM, LYMPH NODES: No significant lymphadenopathy.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Osteopenia and degenerative changes of the visualized spine.PELVIS:PROSTATE, SEMINAL VESICLES: Moderate to marked dystrophic prostatic calcifications.BLADDER: Left bladder diverticulum. | 1.Multifocal renal cell carcinoma with biopsy proven metastatic left lower lobe pulmonary mass. 2.Left adrenal lesion suspicious for metastasis.3.Findings suspicious for right renal vein thrombus. |
Generate impression based on findings. | Pain radiating from back down to posterior thigh. LUMBAR SPINE: The vertebral body heights and disk spaces are preserved. There may be mild narrowing of the L5/S1 neural foramina bilaterally as a result of mild facet joint hypertrophy, however this is equivocal and would be better assessed with cross-sectional imaging.Ovoid lucency within the right iliac wing near the right sacroiliac joint with associated cortical defect on the oblique view is of uncertain clinical significance. The sclerotic margins of this lesion suggests an indolent lesion or possibly postsurgical etiology. RIGHT HIP: Small osteophytes indicate minimal osteoarthritis.LEFT HIP: Small osteophytes indicate minimal osteoarthritis. | 1. Possible mild narrowing of the L5/S1 neural foramina, which may be better assessed with cross-sectional imaging.2. Minimal bilateral hip osteoarthritis.3. Lucent lesion with sclerotic margins in the right iliac wing. This lesion has a benign appearance and may be postsurgical in etiology, such as a bone graft harvest site. However if no such history is available, further evaluation with MRI may be considered if clinically warranted. |
Generate impression based on findings. | Pain. Skiing injury. Four views of the left knee demonstrate no fracture, malalignment, or other findings to account for the patient's pain.The right knee is normal in appearance as seen on frontal views. | No findings to account for the patient's pain. |
Generate impression based on findings. | Pain. Swelling. Three views of the right foot demonstrate no fracture, malalignment, or specific findings to account for the patient's pain. | No findings to account for the patient's pain. |
Generate impression based on findings. | Metastatic breast cancer. Evaluate for progression. One view of the pelvis demonstrates hardware components of a left total hip arthroplasty device situated in near-anatomic alignment. The inferior margin of this device is not included in the field-of-view.Lucent lesions seen on the prior radiograph are again noted on the current study and appear similar to prior. There are no findings to suggest progression of disease.Severe osteoarthritis affects the right hip. Severe degenerative disk disease and facet arthropathy affects the visualized lower lumbar spine. | Metastatic lesions and other findings, appearing similar to prior. |
Generate impression based on findings. | Female 88 years old Reason: right femur fracture s/p nail History: fracture. Pelvis: Sensitivity of the study is limited by overlying bowel gas and stool. The bones are diffusely demineralized. There is mild osteoarthritis of the hips. Again seen is an intramedullary rod and screw device with the attempt affixation of a comminuted intertrochanteric fracture of the femur. The proximal screw tip is unchanged in position and lies at the superior aspect of the femoral head and neck and the threads of the dynamic screw remains not clearly engaged or attached within the femoral neck or head. Femur: Femoral mid-diaphyseal rod is unchanged in position with proper anchoring of the distal fixation screw. Arterial calcifications are noted in the medial soft tissues. | Attempt orthopedic fixation of a comminuted intertrochanteric fracture unchanged in position. |
Generate impression based on findings. | Reason: 78 year old female patient diagnosed with HCC is here foradministration of THERASPHERES in addition to a nuclear medicine study Please refer to interventional radiology study for description of procedure andimages. | Successful Y90 Therasphere administration to liver tumor via the right hepaticartery. Please refer to interventional radiology exam for description of procedure andimages. |
Generate impression based on findings. | 14-year-old male, evaluate for C-spine bullet fragmentsVIEWS: Cervical spine, AP and lateral (two views) 2/23/15 16:52 Unchanged bullet fragments project over the right pedicle of C7. Cervical spine alignment is within normal limits. The prevertebral soft tissues are normal. | Unchanged bullet fragments. |
Generate impression based on findings. | A 48 years old female with hypertension, dyslipidemia and non compliance to medications, referred to cardiac CT because of chest pain to rule out coronary artery disease. CPT Code: 75574 Coronary arteries: LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There are no significant stenoses present in the left main.LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There are no significant stenoses in the proximal or mid LAD. The distal LAD is very small and not well visualized. There is diffuse non-obstructive (<25% stenosis), non-calcified atherosclerosis of the proximal LAD. There is a 25-50% stenosis in the mid LAD.LCx: The left circumflex coronary artery is non-dominant. It courses normally in the left AV groove. There are no significant stenoses in the proximal and mid LCx. The distal LCx and OM are small and not well visualized. RCA: The right coronary artery is large and arises normally from the right sinus of Valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There are no significant stenoses in the right coronary artery. There are non-calcified, non-obstructive plaques in the proximal, mid, and distal RCA (each ~25% stenosis). There PDA is very tortuous but likely without significant stenosis. The PL branch is small and not well visualized. Left Ventricle: Normal LV size with mild left ventricular hypertrophy. Right Ventricle: Normal RV sizes. Left Atrium: Moderate to severe left atrial dilation. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrial volume appears to be normal in size. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Valves: There is no calcification on the aortic or mitral valves.Great vessels: The visualized portions of the thoracic aorta demonstrate no evidence of dissection or aneurysm. The aortic arch is not seen. The main pulmonary artery is normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion. | 1.There are no significant coronary artery stenoses present; however, the distal vessels and branches are small and not well visualized. 2. The patient has several non-obstructive atherosclerotic plaques through out the coronary tree. 3. The overall burden of atherosclerosis is high for a 48 year old woman. 4. Mild left ventricular hypertrophy with moderate to severe left atrial dilation. This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report. |
Generate impression based on findings. | Pain and swelling. Abnormality? There is mild soft tissue swelling, particularly at the fingertip. There is a punctate density seen only on the lateral view dorsal to the head of the middle phalanx which could conceivably represent old trauma, but I see no donor site to confirm an acute fracture fragment. | Soft tissue swelling and punctate density dorsal to the head of the middle phalanx, but I see no definite acute fracture or radiographic features of osteomyelitis. |
Generate impression based on findings. | Post reduction Evaluation of fine detail is limited by overlying cast material. Again seen is an oblique fracture of the distal fibula with approximately 2 mm lateral displacement of the distal fracture fragment. There is also a transverse fracture of the medial malleolus with fracture fragments in near anatomic alignment. There is a minimally displaced fracture of the anterior corner of the tibial plafond. The ankle mortise appears more symmetric on the current study on the prior study. | Ankle fracture status post reduction as above. |
Generate impression based on findings. | Status post fall one week ago. Left hip pain. Left knee pain. Fracture? Four non-weight-bearing views of the left knee are provided. I see no fracture. There is perhaps a small joint effusion. Alignment is within normal limits. Small osteophytes indicate mild osteoarthritis. Arterial calcifications are noted in the posterior soft tissues.Two views of the left hip are provided. I see no fracture or malalignment. Mild osteoarthritis affects the hip. Arterial calcifications are noted in the thigh.Two views of the right hip are provided. I see no fracture or malalignment. Mild osteoarthritis affects the hip. Arterial calcifications are noted within the thigh.AP view of the pelvis shows mild bilateral hip joint osteoarthritis. I see no fracture. Mild degenerative arthritis affects the pubic symphysis. Degenerative arthritic changes also affect the visualized lower lumbar spine. | Mild osteoarthritis of the hips and left knee without fracture evident. |
Generate impression based on findings. | History of sciatica and degenerative disk disease, worsening "fx", lost to follow-up secondary to insurance. Vertebral body heights and intervertebral disk spaces are within normal limits. There is perhaps mild facet joint osteoarthritis at L4/5, with a minimal (grade 1) anterolisthesis of L4. Alignment is otherwise within normal limits. I see no fracture. | Mild facet joint osteoarthritis as above. I see no fracture. |
Generate impression based on findings. | 72 year old man being considered for robotic mitral and tricuspid valve repair. Referred to evaluate cardiovascular anatomy to guide procedure.CPT: 75572 Aortic and Aortic Root. There is a left sided aortic arch with normal brachiocephalic branching pattern. No thoracic aortic dissection is noted; however, the thoracic aorta is mildly dilated (dimensions below). The thoracic aorta has minimal tortuosity. There is mild calcification of the aortic root, moderate calcification of the aortic arch, and mild calcification of the descending aorta. No aortic coarctation is noted. There is mild calcification of the proximal brachiocephalic vessels. Sinus of Valsalva: Width: 39mm x 41mm x 42mmSinotubular Junction: 36x36mmAscending Aorta (6.5cm from annulus): 41x40mmMid Aortic Arch: 36x37mmDescending Aorta: 35x34mmAortic Valve: The aortic valve is trileaflet. There is no significant aortic valve calcification. Mitral Valve: Mild posterior mitral annular calcification is noted.Left Ventricle: The LV is normal in size with normal wall thickness. There is no thrombus noted in the left ventricle. The morphology of the interventricular septum is within normal limits.Right Ventricle: Normal size.Left Atrium: The left atrium is severely dilated. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrium is normal in size. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Pulmonary Artery: Normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Coronary arteries: Because heart rate management was not attempted and nitroglycerin was not administered, this exam was not performed to optimally visualize the coronary arteries. However within the limitations of the study the following observations are made:LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There is no calcification of the left main coronary artery. LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There is moderate calcification of the LAD. LCx: The left circumflex coronary artery courses normally in the the left AV groove. It gives rise to the obtuse marginal branches and a small AV circumflex branch. There is mild calcification of the LCx.RCA: The right coronary artery arises normally from the right sinus of Valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There is no calcification of the RCA. Coronary Bypass Grafts:None present. | 1. Thoracic aorta mildly dilated with mild to moderate burden of atheroslcerosis. 2. Severe left atrial dilation 3. Mild overall burden of coronary calcification. 4. Mild mitral annular calcification.This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report. The abdominal/ pelvis CTA will be reported separately. |
Generate impression based on findings. | Two weeks ago with injury after falling on Christmas tree. Mild osteoarthritis affects the knee and there may be a joint effusion; however, I see no fracture or malalignment. | Mild osteoarthritis and joint effusion without fracture evident. |
Generate impression based on findings. | Pain. Rule out fracture. Three views of the left hand are provided. The bones appear slightly demineralized. There is dorsal soft tissue swelling, but I see no underlying fracture. There is widening of the scapholunate interval suggesting scapholunate ligamentous disruption that may be chronic in etiology; there appears to be volar subluxation of the scaphoid which may also be chronic in etiology.Three views of the right hand are provided. The bones appear slightly demineralized, but I see no fracture. There is widening of the scapholunate interval suggesting scapholunate ligamentous disruption that I suspect is chronic in etiology, as there is also severe narrowing of the radioscaphoid articulation. There also appears to be volar rotary subluxation of the scaphoid which I suspect is chronic in etiology as well. | Findings suggestive of scapholunate ligamentous disruption bilaterally that I suspect is chronic in etiology as there are associated arthritic changes of the wrists. I see no acute fracture. |
Generate impression based on findings. | Clinical question: Fall. Signs and symptoms: Trauma after fall Nonenhanced head CT:Examination demonstrate a thin band of hyperdensity along the right falx measuring approximately 3.5 mm in thickness. Finding is suspicious for a small subdural collection. Recommend follow-up exams.Left posterior temporal -- occipital subgaleal hemorrhage and subcutaneous fat edema is noted.Unremarkable cerebral cortex, cortical sulci, ventricular system, cisterns and spaces and gray -- white matter differentiation.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.Findings and concerns on this exam were discussed with the emergency services Dr. Ben Savage at the time of review of the study. | 1.Small 3.5-mm right-sided falcine subdural hematoma is suspected.2.Unremarkable intracranial contents otherwise.3.Left posterior temporal -- occipital scalp/subgaleal small hematoma. |
Generate impression based on findings. | Clinical question:? Intracranial hemorrhage. Signs and symptoms: Assault with bat and read last of consciousness. Nonenhanced head CT:There is no detectable acute posttraumatic intracranial, calvarial or soft tissues of the scalp findings.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation.Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells. | Negative nonenhanced head CT. |
Generate impression based on findings. | Clinical question: Evaluate status-post right temporal craniotomy for resection of tumor. Signs and symptoms: As above. Unenhanced head CT:Examination demonstrates post operative changes are right anterior temporal and frontal large craniotomy. Surgical cavity containing fluid and air fluid level in the anterior right temporal lobe at the site of lobectomy is noted. A small focus of acute hemorrhage in the dependent portion of surgical cavity is noted laterally. Possibility of associated small adjacent parenchymal hemorrhage cannot be entirely excluded.Epidural air and small amount of fluid collection under the craniotomy flap measures maximum of 12.5-mm in thickness. It results in subtle effect on the adjacent parenchyma and on the right lateral ventricle. There is however no significant midline shift.Dilated supratentorial ventricular system (right greater than left) benign similar to prior exam. Small amount of hemorrhage within the right occipital horn and lateral ventricle is present. Bilateral mastoid air cells and middle ear cavities and paranasal sinuses remain well pneumatized.Unremarkable images through the orbits. | 1.Extensive postoperative changes are large right temporal -- frontal craniotomy as detailed.2.Focus of high density suspected of hemorrhage in the dependent portion of surgical cavity posteriorly is noted, however possibility of adjacent parenchymal hemorrhage cannot be entirely excluded.3.Dilated supratentorial ventricular system without deviation of midline is similar to prior exam. |
Generate impression based on findings. | Clinical question: Out subdural hematoma. Signs and symptoms: Headache. Nonenhanced head CT:There is no detectable acute intracranial process. EG however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation for patient's stated age of 82.Unremarkable calvarium and soft tissues of the scalp.Unremarkable images through the orbits, paranasal sinuses and right mastoid and middle ear cavity.There is complete opacification of left mastoid air cells and left middle ear cavity with retracted tympanic membrane. Findings are consistent with otitis media. | 1.Unremarkable nonenhanced head CT.2.Left-sided otitis media. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Scattered benign calcifications and right lateral focal asymmetry are stable. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. Stable benign low lying axillary lymph node again noted. Other normal sized axillary lymph nodes are present bilaterally. A few benign calcifications are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | altered mental status No evidence of acute ischemic or hemorrhagic lesion.Diffuse moderate to severe non specific small vessel ischemic disease.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion.Moderate to severe small vessel ischemic disease. |
Generate impression based on findings. | 73 old female with history of small cell carcinoma now with abdominal pain and delirium. ABDOMEN:LUNG BASES: Please see chest CT report from the same day for full evaluation of the thorax. LIVER, BILIARY TRACT: The left hepatic lobe abuts and is slightly superiorly displaced by the extensive retroperitoneal lymphadenopathy. There is marked attenuation of the proximal portal vein at the level of the confluence, without complete occlusion, similar or prior. SPLEEN: The splenic vein is thrombosed and there are extensive perigastric varices. The splenic artery is not well visualized and may be occluded. PANCREAS: The pancreatic parenchyma is nearly completely encased by the retroperitoneal lymphadenopathy.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: The bilateral renal veins and arteries are encased and attenuated by the retroperitoneal adenopathy, but without complete occlusion. Thrombus is evident within the left gonadal vein and a collateral vein draining into the left renal vein, similar to prior. There is no evidence of hydronephrosis or hydroureter.RETROPERITONEUM, LYMPH NODES: There is a heterogeneous retroperitoneal mass extending from the gastroesophageal junction to the external iliac veins (axial series, image 37) measuring 14.4 x 13.3 cm, previously 14.8 x 17.2 cm, suggestive of a conglomerate necrotic retroperitoneal lymph nodes, which displaces the aorta anteriorly, encases the celiac axis, SMA, renal arteries and veins as well as the portal vein and SMV. The inferior vena cava is also compressed by the mass, and evaluation for thrombus is suboptimal. Mesenteric lymphadenopathy has increased in size and number. However, reference lesion (axial series, image 69) measures 2.6 x 2.7 cm is unchanged (measured 2.6 x 2.7 cm previously).BOWEL, MESENTERY: There is no evidence of bowel obstruction. The stomach is displaced anteriorly by the retroperitoneal mass. There is colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Severe degenerative changes affect the lower lumbar spine. PELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Marked partially necrotic pelvic lymphadenopathy extending to the level of the external iliac veins bilaterally. For reference purposes a right external iliac chain node (axial series, image 90) measures 2.0 x 2.2 cm, previously 2.0 x 2.2 cm. BOWEL, MESENTERY: Previously seen nonspecific rectal wall thickening has improved. There is no evidence of bowel obstruction. There is colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Severe degenerative changes affect the lower lumbar spine. No suspicious osseous lesions to suggest metastasis.OTHER: A small amount of free fluid is present in the pelvis. | 1.Large retroperitoneal mass which appears to be a conglomerate of necrotic retroperitoneal lymph nodes compatible with metastatic disease, similar to prior. Mass results in encasement of the mesenteric and retroperitoneal vasculature causing narrowing of the portal vein, renal vasculature, and IVC. Splenic vein and artery appear occluded with collateral formation present.2.Interval increase in mesenteric lymphadenopathy.3.Please see dedicated chest CT from same day for details regarding the chest. |
Generate impression based on findings. | Reason: transient numbness/weakness, eval for intracranial process s/p crani for tumor resection History: transient numbness/weakness, eval for intracranial process s/p crani for tumor resection The patient is status post right-sided craniotomy right parafalcine meningioma. Compared there is an additional extra axial mass adjacent to the superior sagittal sinus measuring 13 mm in size which is adjacent to the precuneus and is unchanged.There is redemonstration of hypodensity in the right frontal and parietal lobes subcortical white matter in a pattern suggestive of vasogenic edema.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.2.Redemonstration of vasogenic edema adjacent to the prior tumor bed.3.small right parafalcine meningioma adjacent to the precuneus is stable. |
Generate impression based on findings. | 48-year-old male with history of Crohn's disease status post completion proctocolectomy now with increasing pain. CHEST:LUNGS AND PLEURA: Mild basilar atelectasis. No pleural effusions. Scattered nonspecific pulmonary micronodules.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Hepatic steatosis without focal lesions. SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal simple cyst with additional bilateral subcentimeter renal attenuation lesions too small to characterize.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes of proctocolectomy and end ileostomy. Small foci of pneumoperitoneum from recent surgery. Surgical drain present with tip in the midline pelvis. Normal caliber bowel without evidence of obstruction. No loculated fluid collections to suggest abscess. A few mildly prominent mesenteric lymph nodes are present in the right lower quadrant with minimal surrounding induration, likely post-surgical. There is also a small soft tissue attenuation nodule (series 3, image 143) in the right lower quadrant mesentry which may represent a small postoperative hematoma.BONES, SOFT TISSUES: Midline postsurgical changes to the anterior abdominal wall. Tiny foci of gas are present along the rectus sheath and left inguinal canal, likely postsurgical.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Partially collapsed bladder with foci of air likely from recent instrumentation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Tiny foci of gas are present along the rectus sheath and left inguinal canal, likely postsurgical.OTHER: No significant abnormality noted | 1.Expected postoperative changes of recent proctocolectomy and end ileostomy.2.No evidence of bowel obstruction or abscess. 3.Hepatic steatosis. |
Generate impression based on findings. | 12 year old female felt shoulder pop out of place. Evaluate for dislocation.VIEWS: Right shoulder AP external and internal rotation (two views) 2/23/2015 No evidence of fracture or dislocation. No soft tissue swelling or joint effusion. | Normal examination. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually. Mammography is optimally performed when prior studies are available to detect changes. If the patient's prior mammograms can be submitted, then an addendum to this report will be made.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of bilateral benign biopsies. Two standard digital views of both breasts with repeat right MLO view were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. Bilateral benign calcifications are again noted. Stable normal-sized intramammary lymph node in the left upper outer quadrant. Postbiopsy distortion in the left upper outer breast is unchanged. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | 45-year-old female with history pancreatitis with peripancreatic fluid collections, evaluate for bleeding prior to possible embolization. Evaluation of the lower abdomen and pelvis in portal venous phase limited by suboptimal contrast phase timing. ABDOMEN:CT Angiography: There is no evidence of aortic aneurysm, dissection, or significant stenosis. The origins of the great vessels, celiac axis, SMA, and renal arteries are patent. There is no evidence of active contrast extravasation or pooling on delayed images to suggest acute hemorrhage. Minimal atherosclerotic disease is present. LUNGS BASES: Moderate right pleural effusion with associated basilar compressive atelectasis and mediastinal shift to the left, all slightly decreased from prior. New trace left pleural effusion. Left basilar linear atelectasis/scarring.LIVER, BILIARY TRACT: Focal fatty infiltration along ligamentum teres. SPLEEN: No significant abnormality noted.PANCREAS: Multiple peripancreatic fluid collections, seen extending from pancreatic body area and upward into lower mediastinum are again present appearing similar to prior. Previously described collection adjacent to the spleen (series 16, image 53) measures 3.7 x 7.1 cm, previously 3.2 x 7.1 cm. The contained area of ovoid soft tissue attenuation has decreased in size and could represent proteinaceous debris or old blood products.Additional rim enhancing fluid collection seen in left posterior perinephric/posterior pararenal region which anteriorly displaces left kidney (series 16, image 76) measures 2.7 x 4.2 cm, measured 2.6 x 4.0 cm previously. ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric renal parenchymal enhancement.RETROPERITONEUM, LYMPH NODES: See above. BOWEL, MESENTERY: No significant abnormality noted.OTHER: Moderate abdominopelvic ascites. PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate abdominopelvic ascites. Asymmetric prominence of left iliopsoas muscle, may be reactive in etiology. | 1.Peripancreatic and additional lower mediastinal and retroperitoneal fluid collections appearing similar to prior, given patient's diagnosis of ongoing pancreatitis, suspicious for pseudocyst formation.2.No evidence of active bleeding.3.Large right pleural effusion with underlying compressive atelectasis and mediastinal shift towards left, slightly decreased. |
Generate impression based on findings. | 63 years, Male. Reason: s/p Dobbhoff placement, check line History: s/p Dobbhoff placement Dobbhoff tube tip projects over the proximal gastric body. Nonobstructive bowel gas pattern. Note that the pelvis is excluded from the field-of-view. | Dobbhoff tube tip projects over the proximal gastric body. |
Generate impression based on findings. | 58 years, Male. Reason: NJ placement, h/o acute on chronic pancreatitis c/b large cystic fluid collections, recent stent placed for cyst stent gastrostomy History: as above Bibasal atelectasis. Enteric feeding tube is projected over the stomach and proximal jejunum with tip projected far past the ligament of Treitz, over the right lower quadrant. Cystogastrostomy stent is projected over the gastric body. Additional support wires overlie the patient. Nonobstructive bowel gas pattern. The lower pelvis is not imaged. | Enteric feeding tube is projected over the stomach and proximal jejunum with tip projected far past the ligament of Treitz. |
Generate impression based on findings. | 61-year-old male status post prostatectomy on 1/29/2015 now with right groin swelling, redness, and pain rule out abscess or mass. 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: The right ureter is mildly dilated as it courses around the pelvic collection on the right. The bladder is collapsed with wall thickening/surrounding inflammation. There is right renal cortical scarring without hydronephrosis. Right nonobstructive punctate calyceal calculus are present. The left kidney is severely atrophied.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postoperative changes of gastric banding. Normal caliber bowel without evidence of obstruction. BONES, SOFT TISSUES: A small fat containing umbilical hernia with surrounding fat stranding is present.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. BONES, SOFT TISSUES: There is marked scrotal edema. There is a large multilobulated collection in the right pelvis extending through the right inguinal canal into the scrotum, with extensive surrounding inflammatory fat stranding. This collection compresses the right external iliac vein. Portions of the collection measures slightly above simple fluid attenuation (10-15HU). There is a smaller lobulated fluid collection in the left pelvis which abuts the bladder, also with surrounding fat stranding and adjacent bladder wall thickening. OTHER: No significant abnormality noted | 1.Multiple post-operative fluid collections in the pelvis and extending into the right inguinal canal and scrotum as described above which may represent postoperative lymphocele/seroma. Superimposed infection cannot be excluded. One of the fluid collections abuts the bladder with associated bladder wall thickening and stranding, correlate clinically for cystitis. One of the collections also compresses the right iliac vein. 2.Extensive scrotal edema which may also be postsurgical. Superimposed infection cannot be excluded. 3.Renal atrophy/scarring as described above. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. Bilateral benign morphology masses and benign calcifications are again noted. Normal-sized lymph nodes are again seen in each axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | 82 years, Female. Reason: NGT position History: feels that it is falling out Nasogastric tube tip projects over the gastric body. Residual contrast is noted within the ascending colon. Calcified diverticula pelvis. Surgical clips noted in the right upper quadrant and in the pelvis. Dilated small bowel loops measuring up to 3 cm in the left hemiabdomen. Scattered air within the colon. | Resolving small bowel obstruction. NG tube tip projects over the gastric body. |
Generate impression based on findings. | 27 years, Female. Reason: eval for stool burden History: abd pain Nonobstructive bowel gas pattern. Below average stool burden. Vascular calcifications noted. | Nonobstructive bowel gas pattern. Below average stool burden. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts and tomosynthesis were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. Benign morphology masses in the right breast do not appear significantly changed. Symmetric axillary lymph nodes are present bilaterally. These maintain normal morphology, and are better visualized on this examination compared priors, likely due to differences in positioning. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Female 58 years old Reason: r/o acute process History: abd pain, recently post-op. Per Epic note, patient had recent surgery for peptic ulcer disease. Patient did not complain of diarrhea. CHEST:LUNGS AND PLEURA: Moderate left and small right pleural effusions with overlying atelectasis.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cirrhotic hepatic morphology with mild ascites. Status post cholecystectomy. Hepatic vasculature remains patent. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Right upper pole high attenuation renal lesion is new since prior study in 2006 and measures 1.7 x 1.4 cm (series 4, image 49). No hydronephrosis or nephrolithiasis.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Gastrostomy tube in place. There is a surgical drain with tip in the gastrohepatic region. Mild dilatation of some proximal bowel loops but no evidence of obstruction or fluid collection. There is wall thickening of the cecum to the transverse colon which is suspicious for colitis. Differential diagnosis favors portal colopathy given lack of history of diarrhea, with infectious, inflammatory, and ischemic etiology less likely. BONES, SOFT TISSUES: Mild anasarca.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Wall thickening of the cecum to the transverse colon which is suspicious for colitis. Differential diagnosis favors portal colopathy given lack of history of diarrhea, with infectious, inflammatory, and ischemic etiology less likely. 2.New right upper pole high attenuation renal lesion. Without precontrast CT it cannot be ascertained if this is a high density cyst versus neoplasm. Recommend dedicated renal imaging to further characterize. 3.Bilateral pleural effusions. |
Generate impression based on findings. | 32 year old female with upper abdominal pain. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Status post cholecystectomy.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: Normal caliber bowel without evidence of obstruction. Appendix well visualized and unremarkable. No intraperitoneal free air.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Tubal ligation/occlusion devices are present.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. Appendix well visualized and unremarkable. No intraperitoneal free air.BONES, SOFT TISSUES: No significant abnormality notedOTHER: A small amount of free fluid is present in the pelvis which may be physiologic. | 1.No specific findings to account for patient's symptoms. |
Generate impression based on findings. | 23 years, Male. Reason: fevers w/ ureteral stent placement a few weeks ago History: fevers Nephroureterostomy tube is noted on the left. Calcified stone is noted within the left collecting system. Bullet fragment projects over the right paraspinal area; noted to be in the soft tissues of the back on prior CT. Greater than average stool burden. | Nephroureterostomy tube and calcified stone within the left collecting system. |
Generate impression based on findings. | 32 years, Female, Reason: to evaluate soft tissue infection of the R buttock near groin, r/o gas gangrene or perirectal abscess History: soft tissue infxn of R buttock. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Small splenule's.PANCREAS: 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: FemaleUTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Mildly enlarged right inguinal lymph nodes.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Soft tissue stranding extending along the right gluteal fold and upper thigh with a few foci of subcutaneous air. No focal fluid collection.OTHER: No significant abnormality noted | Soft tissue stranding in the right gluteal fold and upper thigh compatible with cellulitis. A few foci of subcutaneous gas are present, which may be seen in necrotizing fasciitis. |
Generate impression based on findings. | 61 years, Male. Reason: right sided abdominal pain History: right sided abdominal pain Enteric contrast opacifies portions of small and large bowel. Displacement of bowel gas from the right upper quadrant. Right lower zone consolidation and pleural thickening consistent with patient's known lung mass. This is better evaluated on recent chest CT. | Displacement of bowel gas from the right upper quadrant, may be secondary to known lung mass and hepatomegaly. Right lower zone consolidation and pleural thickening is better evaluated on recent chest CT. |
Generate impression based on findings. | Clinical question: Hemorrhage in moyamoya/hemoglobin SS patient. Signs and symptoms: Headache. Nonenhanced head CT:There is no detectable acute intracranial hemorrhage, mass, mass effect, midline shift or hydrocephalus. CT however is insensitive for early detection of acute non-hemorrhagic ischemic strokes.There are ill-defined patchy foci of low attenuation of the right hemispheric subcortical and periventricular white matter which appears a slightly more diffuse compared to prior exam from 2011. There is resultant slight generalized prominence of the left hemispheric cortical sulci and mild ex vacuo dilatation of left lateral ventricle however with maintained midline. There is evidence of calvarial postoperative changes of craniotomy and burr hole on the left similar to prior exam.Unremarkable orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process. 2.Subtle patchy periventricular and subcortical hypoattenuation of white matter in the left hemisphere and with evidence of left sided craniotomy as detailed. |
Generate impression based on findings. | 74 year old female with left lower quadrant pain, evaluate for diverticulitis. ABDOMEN:LUNG BASES: Cardiomegaly. Moderate coronary artery calcifications. Basilar pulmonary nodules measuring up to 8 mm which are not definitively present on prior exams. No consolidation or pleural effusions.LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: Nonspecific hypodense foci within the spleen similar to prior. PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts. Additional complex cystic lesion in the upper pole of the right kidney unchanged in size with small focal calcification. Increased attenuation along the posterior wall is present, new from the prior exam.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Previously seen mesenteric hematoma has resolved. Normal caliber bowel without evidence of obstruction. Focal herniation of portion of antimesenteric transverse colon into small, broad-based umbilical hernia without evidence of obstruction or inflammation. Colonic diverticulosis without specific evidence of complicated diverticulitis.BONES, SOFT TISSUES: Sclerosis of the osseous structures.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Atrophic or absent.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Previously seen mesenteric hematoma has resolved. Normal caliber bowel without evidence of obstruction. Focal herniation of portion of antimesenteric transverse colon into small, broad-based umbilical hernia without evidence of obstruction or inflammation. Colonic diverticulosis without specific evidence of complicated diverticulitis.BONES, SOFT TISSUES: Sclerosis of the osseous structures.OTHER: No significant abnormality noted | 1.No acute findings to account for patient's symptoms.2.Umbilical hernia containing transverse colon without evidence of complication.3.Diverticulosis without diverticulitis. 4.Bibasilar pulmonary nodules measuring up to 8 mm. Follow up recommended.5.Complex right renal upper pole lesion. Increased attenuation within the posterior wall may be related to volume averaging, but recommend continued follow-up or further characterization with ultrasound. |
Generate impression based on findings. | 14-year-old male status post patella reductionVIEWS: Left knee, AP, oblique, and lateral (3 views) 2/24/15 3:46 Large joint effusion. The patella is slightly laterally subluxed. Small fracture fragment anterior to the lateral femoral condyle is again visualized. | Large joint effusion and small fracture fragment anterior to the lateral femoral condyle. MRI is recommended for further evaluation if clinically warranted. |
Generate impression based on findings. | 39 year old male with abdominal pain, rule out acute process. ABDOMEN:LUNG BASES: Left basilar consolidation/ground glass opacities and right basilar groundglass opacities suspicious for pneumonia. No pleural effusions.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Status post splenectomy.PANCREAS: Evaluation of the pancreas is somewhat limited by metallic streak artifact, within this limitation previously described pancreatic body lesion is no longer visualized and low attenuation pancreatic tail lesion has decreased in size. The pancreatic duct is nondilated.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: A common celiac/superior mesenteric artery is noted, a normal variantBOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction.BONES, SOFT TISSUES: There is a mild age indeterminate compression deformity of T11, new compared to 2005.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Basilar pneumonia.2.No acute abnormalities in the abdomen or pelvis.3.Mild age indeterminate compression deformity of T11.4.Evaluation of the pancreas is somewhat limited by metallic streak artifact, within this limitation previously described pancreatic body lesion is no longer visualized and low attenuation pancreatic tail lesion has decreased in size. |
Generate impression based on findings. | 65 years, Male. Reason: Dobbhoff placement History: same Enteric feeding tube is partially obscured with tip projecting over the gastric body. Support devices are unchanged. Again seen are multiple surgical clips and 8mm radiodensity projected over the pelvis. Nonobstructive bowel gas pattern. Cardiomegaly and bibasilar pulmonary opacities noted. | Enteric feeding tube tip projects over the gastric body. |
Generate impression based on findings. | 14-year-old male with left knee painVIEWS: Pelvis, AP and frog leg (two views) 2/24/15 2:31 Both femoral heads are well directed with respect to the well formed acetabula. No fracture or malalignment. The osseous structures of the pelvis are normal for the patient's age. | Normal examination. |
Generate impression based on findings. | Male 66 years old Reason: ileus? History: pseudomonal bacteremia with dilated loops of bowel Limited exam secondary to lack of intravenous contrast. Evaluation of visceral and facet pathology are suboptimal.ABDOMEN:LUNG BASES: Small right pleural effusion and bibasilar consolidation with air bronchograms. Calcified right hilar lymph nodes likely secondary to prior infection. Moderate coronary arterial and valvular calcifications.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Hypodense lesion within the inferior pole of the right kidney measuring 5.4 x 5.5 cm (series 3, image 87) consistent with a renal cyst, and better characterized on recent renal ultrasound.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Gaseous distention of a few large loops of large bowel most prominent in the ascending and transverse colon measuring up to 7.6 cm in diameter. No bowel wall thickening or fluid collections. No evidence of obstruction. No intraperitoneal free air or pneumatosis.BONES, SOFT TISSUES: Moderate degenerative changes of the thoracic spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Collapsed bladder with Foley catheter in place. Air within the bladder lumen likely iatrogenic in nature.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Left-sided diverticula.BONES, SOFT TISSUES: Moderate degenerative changes of the lumbar spine. Bilateral hernias with a small amount of fluid in the right hernia sac.OTHER: No significant abnormality noted | 1.Findings consistent with mild colonic ileus without intraperitoneal free air.2.Bibasilar consolidations suspicious for pneumonia. |
Generate impression based on findings. | 75 years, Male. Reason: r/o megacolon History: positive c diff and abdominal pain with distension There are mildly dilated loops of small bowel and gas filled colon, compatible with an ileus pattern. Gastric distention with air fluid level noted. Postsurgical changes at the gastroesophageal junction. | Mildly dilated loops of small bowel and gas filled colon, compatible with an ileus pattern. |
Generate impression based on findings. | 33 years, Female. Reason: assess OG tube placement History: s/p OG tube placement Diffuse bilateral patchy airspace opacities. Enteric feeding tube is coiled within the gastric fundus with tip projected over the gastric body. Nonobstructive bowel gas pattern. The lower pelvis is not imaged. | Enteric feeding tube is coiled within the gastric fundus with tip projected over the gastric body. Patchy airspace opacities bilaterally compatible with clinical diagnosis of pneumocystis pneumonia. |
Generate impression based on findings. | 14-year-old male, rule out dislocationVIEWS: Left knee, AP, oblique, lateral, and sunrise (4 views) 2/24/15 2:51 Large joint effusion. Small linear density anterior to the lateral femoral condyle may represent a small fracture fragment. The patella is laterally subluxed. | Large joint effusion and small fracture fragment anterior to the femoral condyle. If further evaluation is clinically warranted, MRI is recommended. |
Generate impression based on findings. | 43 years, Female, Reason: abdominal pain History: abdominal pain. 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: FemaleUTERUS, ADNEXA: Interval hysterectomy.BLADDER: No significant abnormality notedLYMPH NODES: Borderline enlarged right inguinal node.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No specific findings to account for the patient's symptoms. If clinical symptoms persist, a contrast-enhanced study may be considered. |
Generate impression based on findings. | 74 years, Male. Reason: SBO, history of cancer. History: N/V/abdominal pain Nonobstructive gas pattern. Moderate osteoarthritis affects the bilateral hips. Lung base are clear. | Nonobstructive gas pattern. |
Generate impression based on findings. | 36 years, Female. Reason: evaluate for obstruction History: constipation, nausea/vomiting Central venous catheter in situ with tip projected over the right atrium. Enteric contrast opacifies the distal large bowel. Nonobstructive bowel gas pattern. Average stool burden. Bilateral lower zone reticulonodular opacities. | Nonobstructive bowel gas pattern. Average stool burden. |
Generate impression based on findings. | Reason: PE History: Chest pain x 3 weeks; DOE PULMONARY ARTERIES: No evidence of pulmonary embolism. The main pulmonary artery is normal in caliber.LUNGS AND PLEURA: Mild subsegmental and dependent atelectasis/scarring. No focal air space consolidation. No pleural effusions.No suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: The heart is enlarged, with small pericardial fluid. No visible coronary artery calcification.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. Probable left renal cyst is incompletely evaluated on non-dedicated imaging. Status post splenectomy. | No evidence of pulmonary embolism or other acute cardiopulmonary abnormality.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Diaphragmatic hernia repairVIEW: Chest AP and abdomen AP ET tube tip at the level of the thoracic inlet. NG tube tip in the stomach. Right upper extremity tip coiled in the right axillary vein. Cardiothymic silhouette at the upper limits of normal. Postsurgical changes from diaphragmatic hernia repair in the right lung base. Patchy atelectasis in the right lung. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum. | Patchy atelectasis in the right lung. |
Generate impression based on findings. | male with sepsis, peritoneal catheter, worsening abdominal painVIEW: Abdomen AP Enteric tube tip and side-port in the stomach. Peritoneal catheter is coiled with its tip in the pelvis. Right femoral catheter tip in the right common iliac vein. Surgical suture in the right lower abdomen. The bowel gas pattern is disorganized without evidence of obstruction. No bowel wall pneumatosis or evidence of free air. | Disorganized bowel gas pattern without obstruction.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | History of subglottic stenosisVIEW: Chest AP 2/24/15 Tracheostomy tube and NG tube again noted. Cardiothymic silhouette normal. Right upper lobe atelectasis has improved. No pleural effusion or pneumothorax. | Right upper lobe atelectasis has improved in the interval. |
Generate impression based on findings. | 4 year old female with cough and fever for 5 days. Evaluate for pneumonia.VIEWS: Chest AP/lateral (two views) 2/23/2015 Cardiothymic silhouette is normal. Peribronchial thickening and left basilar streaky opacities likely atelectasis. No pleural effusion or pneumothorax. | Reactive airway disease or bronchiolitis pattern. |
Generate impression based on findings. | 75 years, Female. Reason: Eval NGT History: NGT Enteric feeding tube in situ with tip projected over the pylorus. Surgical clips projected over the left upper quadrant, left lower quadrant and pelvis. Nonobstructive bowel gas pattern. The lower pelvis is not imaged. | Enteric feeding tube in situ with tip projected over the pylorus. |
Generate impression based on findings. | Feeding tube placementVIEW: Chest AP and abdomen AP Feeding tube tip in the stomach. Left upper extremity PICC with tip at the confluence of the brachiocephalic veins. Cardiothymic silhouette normal. Hyperinflated left lung with patchy atelectasis at the left lower lobe. No pleural effusion or pneumothorax. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum. | Feeding tube tip in the stomach. |
Generate impression based on findings. | There is no acute fracture. There is no soft tissue swelling. There is no orbital fracture. The globes are intact. There is no intraorbital hematoma or stranding. The imaged paranasal sinuses and mastoid air cells are clear.There is a focal left inferior orbital wall bony dehiscence measuring 7 mm in transverse dimension without evidence of herniation (coronal series 80322 image 73). This focal dehiscence is just medial to the left infraorbital foramen. There is no regional stranding, or air-fluid level in the left maxillary sinus to suggest acute process. Given its appearance, this is felt to represent a chronic process, and given absence of herniation of fat through the defect, this may represent anatomic variation or a developmental/congenital finding.There are prominent bilateral level Ib lymph nodes measuring up to 1.2 cm in short axis on the left, nonspecific and likely reactive in absence of a known malignancy. | No acute fracture. |
Generate impression based on findings. | 14-month-old female with Dobbhoff tube placement.VIEW: Abdomen AP (one view) 2/23/2015 17:19 Dobbhoff tube tip in the gastric antrum or duodenal bulb.Moderate fecal burden with a nonobstructive bowel gas pattern. | Dobbhoff tube tip in the gastric antrum or duodenal bulb. |
Generate impression based on findings. | 2-Year-old male with respiratory distressVIEW: Chest AP (one view) 2/24/15, 4:22 Left PICC tip in SVC. NG tube tip at EG junction. Endotracheal tube has been removed.The cardiothymic silhouette is normal.Interval improvement in right upper lobe and retrocardiac opacities. Right upper lobe opacity has resolved. Some persistent left lower lobe opacity is noted. | Decrease in lung opacities.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Worsening breathingVIEWS: Chest AP and lateral Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. Peribronchial wall thickening with subsegmental atelectasis in the right lower lobe and left lower lobe. No pleural effusion or pneumothorax. | Bronchiolitis or reactive airway disease. |
Generate impression based on findings. | Pneumonia and influenza. History of prolonged intubation.VIEW: Chest AP (one view) 02/24/15, 0429 In the interval atelectasis of right lower and middle lobes has developed. Opacity in left lower lobe continues. Cardiac silhouette size is probably normal. Right thoracolumbar curve is again seen. | Development of lobar atelectasis on right. |
Generate impression based on findings. | Cough feverVIEWS: Chest AP and lateral Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. Peribronchial wall thickening with subsegmental atelectasis in the left lower lobe. No pleural effusion or pneumothorax. | Bronchiolitis or reactive airway disease. |
Generate impression based on findings. | 31-day-old male, evaluate OG placementVIEW: Chest AP, abdomen, AP (two views) 2/23/15 18:41 ETT tip below the thoracic inlet. Enteric tube tip and side-port in the stomach.The cardiothymic silhouette is normal. Mild upper lobe atelectasis is again noted. No pneumothorax. Disorganized bowel gas pattern. | Enteric tube tip and side port in the stomach. Right upper lobe atelectasis is unchanged. |
Generate impression based on findings. | Ms. Jacox is a 54 year old female recalled from screening mammogram for an asymmetry in the left inferior breast. An ML view, MLO view and one spot compression view of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Previously identified focal asymmetry in the left inferior breast disperses into normal breast parenchyma on spot compression views. There are no new suspicious microcalcifications or areas of architectural distortion identified in the left breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | ET placementVIEW: Chest AP 2/23/15 ET tube tip below thoracic inlet and above the carina. Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. Minimal patchy atelectasis in the right upper lobe. No pleural effusion or pneumothorax. The stomach is distended. | ET tube tip below thoracic inlet and above the carina. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are digital mammographic images of left breast (4/21/14) and ultrasound images of left breast (4/21/14) performed at Northwestern Memorial Hospital. For comparison, digital mammographic images of both breasts (1/29/13, 2/27/13) are available. DIGITAL MAMMOGRAPHIC IMAGES OF LEFT BREAST (4/21/14):The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. A few benign calcifications are present.No dominant mass, suspicious microcalcifications or areas of architectural distortion are noted in left breast. ULTRASOUND IMAGES OF LEFT BREAST (4/21/14):A normal appearing intramammary lymph node is visualized in the left 2:30 position.No abnormal findings are present. | No mammographic evidence of malignancy. BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | 2 old male with history of pneumothorax status post chest tube removalVIEW: Chest AP (one view) 2/24/15, 6:19 Enteric tube side-port at the EG junction. UVC tip in the hepatic vein. The cardiothymic silhouette is normal.Small unchanged right pneumothorax. No focal lung opacity is present. | Small right pneumothorax, unchanged.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of sister and maternal aunts diagnosed with breast cancer. Two standard digital views of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Biopsy clips are noted in the upper breasts bilaterally. Scattered groups of benign appearing calcifications are seen in the right breast. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 2 - Benign finding.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Brain: No acute intracranial hemorrhage or CT evidence of acute large territorial ischemia. Moderate prominence of the ventricles and sulci, likely age related volume loss. Moderate periventricular and subcortical white matter hypoattenuation consistent with small vessel ischemic disease of indeterminate age. There are no masses, mass effect or midline shift. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are clear. Mild proptosis, right greater than left. Partially empty sella is noted.Spine: Alignment is anatomic. There are no acute fractures or traumatic subluxations. There are dystrophic calcifications/ossification in the left paramedian posterior soft tissues of the neck. Atherosclerotic calcifications at the carotid bifurcations bilaterally. No significant interval change in the 5-mm pleural-based right upper lobe nodule. Paraseptal emphysema in the visualized apices. Multilevel spondylosis as belowC2/3: No central spinal canal stenosis.C3/4: Disk osteophyte complex with central disk protrusion, uncal vertebral hypertrophy and left facet arthropathy results in mild right and moderate left neural foraminal stenosis and moderate to severe central spinal canal stenosis.C4/5: Disk osteophyte complex, uncal vertebral hypertrophy, and facet arthropathy results in moderate right and mild to moderate left neural foraminal narrowing and severe central spinal canal stenosis.C5/6: Disk osteophyte complex, uncal vertebral hypertrophy and facet arthropathy results in mild right and severe left neural foraminal narrowing and mild to moderate central spinal canal stenosis.C6/7: Disk osteophyte complex, uncal vertebral hypertrophy and facet arthropathy results in mild to moderate bilateral neural foraminal narrowing and mild central spinal canal stenosis.C7/T1: Disk osteophyte complex and facet arthropathy results in severe right and mild left neural foraminal narrowing. No significant central spinal canal stenosis. | 1.No acute intracranial hemorrhage.2.No acute fracture or subluxation.3.Multilevel cervical spondylosis with central spinal canal stenosis which is most severe at C3/4 and C4/5. |
Generate impression based on findings. | A 13-year-old male with increasing abdominal pain, concerning x-ray. Evaluate for small bowel obstruction. ABDOMEN:LUNG BASES: Bilateral small pleural effusions with adjacent atelectasis, right greater than left.LIVER, BILIARY TRACT: Normal appearance of the liver with no evidence of intra-or extrahepatic ductal dilatation. The gallbladder is normal in appearance with no evidence of sludge or gallstones. Perihepatic fluid is noted.SPLEEN: The spleen is normal in appearance. Perisplenic fluid is noted. PANCREAS: Normal with no evidence of pancreatic ductal dilatation.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Normal with no evidence of hydronephrosis or nephrolithiasis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Feeding tube tip in the stomach. There are multiple markedly distended small bowel loops up to 4.0 cm (series 80272, image 73) with no definite transition point identified however the colon is collapsed in its entirety. The appendix is not definitively visualized.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Large amount of free abdominal fluid. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Marked distended small bowel loops with distally collapsed colon as described above. BONES, SOFT TISSUES: No significant abnormality notedOTHER: Large amount of free pelvic fluid with an air fluid level consistent with pneumoperitoneum (series 3, image 120). | 1. Small bowel obstruction with pneumoperitoneum and the appendix not definitively visualized. Constellation of findings are suggestive of a perforated appendix. 2. Large amount of free fluid in the abdomen and pelvis with pneumoperitoneum.3. Bilateral small pleural effusions, right greater left. Findings were discussed by on-call radiology resident Dr. Jeffrey Bonham with surgery team on 2/23/2015 at 7 PM. |
Generate impression based on findings. | Ms. Gnutek is a 66 year old female with a personal history of right breast lumpectomy in June 2006 for IDC followed by chemotherapy, radiation, and aromatase inhibitor. Family history of breast cancer in mother (diagnosed at the age of 64) and sister (diagnosed at the age of 61). She has no current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the right breast. There are stable postsurgical changes including architectural distortion, increased density, surgical clips and benign dystrophic calcifications present within the right lumpectomy site. Biopsy marker clip is identified in the left anterior breast. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. Benign lymph nodes project over the axillae. | Stable postsurgical changes of the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Female 64 years old Reason: 64 y/o F w/ Hx of Hep C who p/w R back pain radiating to R pelvis and CVA tenderness r/o renal stone. History: CVA tenderness w/ R back and R pelvis pain Limited exam secondary to lack of intravenous contrast. Evaluation of solid organs and vasculature are suboptimal.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 nephrolithiasis or hydronephrosis.RETROPERITONEUM, LYMPH NODES: Incompletely imaged calcified mediastinal lymph nodes likely secondary to prior granulomatous disease.BOWEL, MESENTERY: Normal appendix.BONES, SOFT TISSUES: No significant abnormality noted OTHER: 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 | Limited exam secondary to lack of intravenous contrast which makes evaluation of solid organs and vasculature are suboptimal. Given these limitations, there are no acute findings to explain patient's right back/pelvis pain. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of benign left surgical biopsy in 1994. Two standard digital views and tomosynthesis of both breasts were performed and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Scar marker noted in the left upper outer breast with slight architectural distortion, compatible with postoperative change. No suspicious masses, microcalcifications or suspicious areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | 12-year-old male with history of pain/right neck swelling evaluate for abscess. There is marked symmetric enlargement of the palatine and adenoid tonsils. The adenoid tonsils appear heterogeneous, but there is no evidence of fluid collection to suggest an abscess. The retropharyngeal space is within normal limits. There is significant mucosal thickening and obstruction of the left nasal passage with inspissated secretions and mild mucosal thickening of the maxillary and scattered ethmoid sinuses. There are scattered enlarged cervical lymph nodes. The airway is patent. The salivary and thyroid glands are normal. | 1. Marked symmetric enlargement of the palatine and adenoid tonsils. Heterogeneous appearance of the adenoid tonsils may represent phlegmonous transformation but there is no evidence of drainable fluid collections.2. Scattered enlarged cervical lymph nodes, likely reactive in etiology.3. Marked narrowing of the left nasal passage with secretions. |
Generate impression based on findings. | A patient submitted outside study for review. Submitted for review are ultrasound images of right breast (4/3/14, 4/30/14) performed at Regenstein Breast Imaging Center. Image quality is limited due to strong shadowing artifacts.A 23 mm round anechoic mass is visualized at 8:30 position in the right breast. There is a smaller round anechoic mass next to the 23 mm mass. Both masses appear simple cysts. Per outside radiology report, aspiration was performed for the larger mass, although a needle is not imaged at the time of aspiration. Images annotated as "POST ASP" show that the large cyst is no longer present. | Status post cyst aspiration for right simple cyst.BIRADS: 2 - Benign finding.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Female 41 years old Reason: lumbar pain History: lumbar pain. Severe degenerative disk disease affects L5/S1. The remaining intervertebral spaces appear intact and the vertebral body heights are preserved. Alignment is within normal limits. | Degenerative disk disease at L5/S1. |
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