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Generate impression based on findings. | Male 25 years old Reason: r/o abscess History: Crohn's disease, diffuse ab pain, WBC 30 w/ left shift ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Subcentimeter hypodense lesions which are too small to characterize and are unchanged. These likely represent hepatic cysts given stability and the patient's age.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Non-obstructive bilateral renal calculi, unchanged.RETROPERITONEUM, LYMPH NODES: Mild lymphadenopathy adjacent to enhancing fluid collection.BOWEL, MESENTERY: Postoperative changes of ileocecectomy and ileo-transverse colon anastomosis are again seen. Marked thickening and enhancement of neoterminal ileum measuring up to 6.1 cm best seen on coronal images (series 8038, image 57). In the central abdomen adjacent to the surgical anastomosis, there is a lobulated, thick-walled enhancing fluid collection measuring 2.9 x 2.7 cm in axial dimension (series 4, image 48) and 3.6 cm in craniocaudal dimension (coronal series the 8038, image 53). This finding is suspicious for abscess.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Trace pelvic ascites. | 1.Fluid collection in the mid abdomen adjacent to ileo-colonic anastomosis suspicious for abscess.2.Marked enhancement and thickening of the neoterminal ileum. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of breast reduction surgery 20 years ago. 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 almost entirely fatty, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | 82 y/o female with lymphoma and known mets to left shoulder with recent trauma to left shoulder. Please evaluate for fracture. History: Decrease ROM in left shoulder with pain The bones are demineralized. There is mild deformity and mottled appearance of the glenoid and scapular neck, compatible with the patient's known lymphoma. Moderate osteoarthritis affects the glenohumeral joint. The alignment is within normal limits. We see no discrete fracture. | Osteoarthritis of the shoulder and known lymphoma of the scapula. We see no fracture. |
Generate impression based on findings. | There are multiple high attenuating intraparenchymal lesions which are highly suspicious for acute hemorrhages and may represent hemorrhagic metastases. Left basal ganglia lesion measures 1.9 x 1.8 cm (series 2, image 19). Right inferior frontal lobe lesion measures 1.6 x 1.4 cm (series 2, image 12). An additional 5-mm focus in the right temporal lobe is noted (series 2, image 11). The aforementioned left basal ganglia and right inferior frontal lobe lesions demonstrate surrounding vasogenic edema. The left basilar ganglia lesion has mass effect upon the anterior horn of the left lateral ventricle without significant midline shift. The ventricles and sulci are otherwise normal in size. There is an additional 5-mm (series 2, image 26) dural based hyperattenuating lesion without obvious defined osseous lesion; however there is mild irregularity of the inner table overlying this lesion, perhaps relating to periosteal reaction. Asymmetric soft tissue thickening along the left lateral temporal region is noted without a discrete mass. There are no extraaxial fluid collections or subdural hematomas. The visualized portions of the paranasal sinuses and mastoid air cells are clear. | 1. Multiple high attenuating intraparenchymal lesions are highly suspicious for acute hemorrhages and may represent hemorrhagic metastases as above, with associated vasogenic edema and mild mass effect.2. Small anterior frontal extraaxial mass with questioned subtle bony change, likely representing an additional metastasis.3. Left anterior temporal scalp thickening, without discrete mass or bony abnormality, which may correlate with palpable finding.Findings were discussed by the overnight resident, Dr. Jeff Bonham, with the referring clinical service. The patient had been transferred to Lurie Children's Hospital and the clinical team was aware of these findings at the time of transfer. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of a right breast cyst removed. 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. Multiple benign-appearing masses appear stable bilaterally. 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. | Male 45 years old; Reason: Multiple cavities, stem cell transplant patient, neutropenic, r/o abscess/infection Note is made of multiple dental fillings. The crowns of the other teeth are missing, presumably secondary to dental caries.Poorly defined round lucency in the left mandibular body at the roots of the left maxillary premolars is nonspecific, however we cannot exclude the possibility of infection. Further evaluation with dedicated dental radiographs may be helpful if clinically warranted. | Poor dentition as described above. Poorly defined round lucency at the roots of the left mandibular premolars is nonspecific, though we cannot exclude the possibility of an abscess. Dedicated dental radiographs may be helpful if clinically warranted. |
Generate impression based on findings. | Right lower extremity pain Mild curvature of the lumbar spine is noted and may be artifactual from patient positioning.The bones are demineralized. Mild multilevel degenerative disk disease affects the lumbar spine. Mild facet joint osteoarthritis affects the lower lumbar spine, with grade 1 anterolisthesis of L4 on L5. There is possible narrowing of the neural foramina at L5/S1. Mild vertebral body endplate concavities are likely chronic.Surgical clips are noted in the right hemiabdomen. | Degenerative changes, as described above. |
Generate impression based on findings. | Evaluation is somewhat limited a thin section images especially facet joint at postcontrast images were not obtained through the orbits/cavernous sinus. Dedicated IAC images are somewhat limited by patient motion. Direct comparison of the various lesions is somewhat difficult secondary to differences in technique across different exams, especially with regards to the cervical medullary junction mass and degree/extent of enhancement and change in cystic components.There is redemonstration of a left orbital mass along the distal intracanalicular and orbital portions of the left optic nerve, that is difficult to measure. There is again mild compression of the medially deviated left optic nerve by the meningioma, unchanged. There is current coronal STIR images are not available, the mass is likely best delineated on the current exam a coronal T2 weighted images, where it measures 1.6 cm transverse by 1.5 cm CC on 701/25, similar to that of the prior exam from November 2014, although increased since the remote exam of September 2013 where it measured 1.3-cm transverse by 1.2 cm CC. Previously noted overlying enhancement and T2 hyperintensity of soft tissue thickening in the left upper eyelid is not well assessed with current sequences.The bilobed appearing T2 hypointense mild heterogeneously enhancing mass centered in the left cavernous sinus with suprasellar and perimesencephalic cistern components again appears similar in size. The meningioma again measures 1.1-cm transverse by 1.8 cm CC by 2.8-cm AP. While there is encroachment along left Meckel's cave, right Meckel's appears clear without abnormal mass or enhancement within limitations of the section postcontrast images which are dedicated to the IACs.There is redemonstration of an enhancing nodule in the right juxtasellar location, just medial to the right internal carotid artery. This most likely represents a small meningioma given its dural abutment, and continues to measure approximately 5 x 7 mm unavailable imaging, grossly similar to the most recent comparison, although again slightly increased in size since more remote exams.There is redemonstration of an enhancing mass in the right internal auditory canal again measuring 8 x 6 mm in greatest axial dimensions by 5 mm CC, consistent with a vestibular schwannoma. This has minimally progressed since the remote 2012 exam but is not significantly changed compared to more recent priors. A left internal auditory canal enhancing mass is also unchanged, again measuring 8 x 5 mm in greatest axial dimensions, by 5 mm CC. However, this is noted to be slightly increased in size since the remote exam of September 2013.Postoperative changes are seen along the left middle cranial fossa laterally with foci of susceptibility as well as the ill-defined enhancement in STIR hyperintensity in the adjacent left temporalis muscle posteriorly. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is a small left maxillary sinus mucosal retention cyst.There is a stable heterogeneously enhancing cervicomedullary intramedullary mass which demonstrates T2 hyperintensity with a few central focal cystic appearing areas. Compared to more remote exams, some of the cystic areas have increased in size, with overall increased size of the mass especially compared back to the remote June 2012 exam, as well as increased expansion of the cervical medullary junction especially dorsally. A compared to the most recent exam from 11/24/2014, there appears to be slight increased conspicuity and margin convexity of the tiny cystic components. The mass again overall measures 2.3-cm AP on sagittal T1 images, compared to previous 2.1 cm in April 2014, 2.0 cm in September 2013, and 1.6 cm in June 2012. The mass measures approximately 3.3 cm CC currently. This is most suggestive of an ependymoma. There is significant crowding at the level of the foramen magnum and upper cervical cord with near complete effacement of surrounding CSF space. CSF flow imaging demonstrates reduced biphasic CSF flow at the level of foramen magnum and cervicomedullary junction dorsally. No significant flow is seen through the cerebral aqueduct or fourth ventricle.There is an additional stable intramedullary mass with expansion of the cord at the C3 level, measuring approximately 7 mm AP by 9 mm CC. There is additional mildly expansile STIR hyperintensity corresponding foci of enhancement within the cord at the lower C4 level of the mid C6 level, the upper T3 level consistent with additional intramedullary masses. Previous remote spine imaging do suggest these findings, although they have progressed and are much more conspicuous on the current exam, especially at lower cervical and upper thoracic levels not included within the field of view on more recent comparison exams.There is also a dural based mass at the dorsal midline C2 level which demonstrates homogeneous enhancement, again measuring 9 mm CC x 7 mm AP, abutting the dorsal cord and most consistent with a meningioma. There is an additional similar appearing dural based enhancing mass at the T1-T2 level dorsally measuring 12 mm CC by 7-mm AP. Axial images are not provided through this level. | 1. Somewhat limited exam due to differences in technique compared to prior exams, with lack of dedicated orbital images. Grossly stable left orbital meningioma, left cavernous sinus, and bilateral vestibular schwannomas. Smaller probable meningioma just medial to the cavernous right internal carotid artery is not as well delineated on the current exam but does not appear significantly changed.2. No significant interval recent change in size of cervical cervicomedullary junction presumed ependymoma although there is favored progressive slight increased size of the cystic components. Sagittal 3D T2 images suggested for future follow-up for detailed evaluation of these cystic components. CSF flow imaging demonstrating decreased biphasic flow dorsally along the foramen magnum and upper cervical cord at the level of the expansile mass.3. No significant interval change in additional expansile C3 intramedullary mass consistent with known ependymoma. Additional intramedullary slightly expansile T2 hyperintense enhancing lesions identified at the C4, C6, and T3 levels, progressed since more remote exams.4. Persistent mid C2 and T1-T2 level dorsal meningiomas, which have at most minimally progressed since remote exams. |
Generate impression based on findings. | 46 year-old female, with right lumpectomy in 2007 followed by mastectomy for recurrent invasive ductal carcinoma, grade III/III on 1/31/2011. Also post radiation and chemotherapy. She had LEFT sentinel lymph nodes biopsy, which were negative for carcinoma. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Multiple surgical clips are present in the left axilla. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in left breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, left unilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of right breast cyst removed. Maternal aunt 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. An asymmetry is seen in the left outer breast at middle depth. No suspicious microcalcifications or areas of architectural distortion are present. | Asymmetry in the left breast. Comparison should be made to prior outside examinations. If those cannot be obtained, then this finding should be further evaluated with spot compression views and possible ultrasound.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: OB - OLD FILM FOR COMPARISON |
Generate impression based on findings. | Reason: Screening visit for EMPROVE clinical trial IRB# 13-0530 History: COPD LUNGS AND PLEURA: Severe lower lobe predominant emphysema, similar in appearance to the prior exam, centrilobular in the upper lobes but possibly panacinar in the lower lobes.Hyper expansion of the lower lobes, with stable compressive atelectasis involving the middle lobe and lingula.No pneumothorax.Stable calcified scarring at the lung apices.Scattered benign appearing micronodules and scattered subsegmental atelectasis/scarring are unchanged.No new suspicious pulmonary nodules or masses.No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without significant pericardial effusion. Severe coronary artery calcification. Severe atherosclerotic calcification of the thoracic aorta and its branches.No mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative disease of the thoracic spine, with stable compression deformities at multiple vertebral body levels. Status post vertebroplasty involving a low thoracic vertebral body.A previously described sclerotic focus in the posterior left seventh rib is unchanged.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Atherosclerotic calcification of the abdominal aorta and its branches. Subcentimeter hepatic hypodensities are unchanged, likely benign. | Severe lower-lobe predominant emphysema, without significant interval change. |
Generate impression based on findings. | Brain: There is a right parietal subgaleal hematoma measuring up to 11 mm (coronal series 80273, image 64) without underlying calvarial fracture. No acute intracranial hemorrhage. Encephalomalacia of the right parietal lobe with associated ex vacuo dilatation consistent with prior remote ischemic insult. There is an additional region of encephalomalacia in the left cerebellum. No CT evidence of acute large territorial ischemia. Prominence of the ventricles which is out of proportion to the sulci is nonspecific. Periventricular and subcortical white matter hypoattenuation consistent with age indeterminate small vessel ischemic disease. There are no masses, mass effect or midline shift. The visualized portions of the paranasal sinuses and mastoid air cells are clear. Dystrophic calcifications of the limbus along both globes is noted. Spine: There is mild rightward convexity of the cervical spine. Vertebral body heights are well-maintained without evidence of acute fracture or traumatic subluxation. Multilevel facet arthropathy, uncovertebral hypertrophy, and severe disk space narrowing. Extensive soft tissue, left greater than right, dorsal to the tip of the dens resulting in moderate to severe narrowing of the central spinal canal at C1 and C2 levels. Additionally, there is grade 1 anterolisthesis of C1 on C2 of the lateral mass on the right, which is best appreciated on the sagittal images. Nonunion of posterior arch of C1 is noted. Significant central spinal canal stenosis at C2/3. Degenerative joint disease at the temporomandibular joints bilaterally. | 1.Right parietal subgaleal hematoma without evidence of intracranial hemorrhage.2.No acute fracture.3.Multilevel cervical spondylosis with moderate to severe central spinal canal stenosis at C1/2 and C2/3, with extensive soft tissue dorsal to the dens, which may relate to underlying degenerative reactive changes, versus less likely inflammatory arthritis. Please correlate clinically.4.Disproportionate prominence of the ventricular system as above is nonspecific. Clinically correlate for NPH. |
Generate impression based on findings. | Clinical question: Assess for progression of the small cell carcinoma. Signs and symptoms: Gadolinium,. Enhanced head CT:New since prior exam is a single superficially located focus of enhancement along the superior left temporal gyrus posteriorly measuring at 6.5-mm in transaxial dimensions. The findings demonstrates no surrounding edema or any appreciable mass effect and highly suspected of a metastatic focus.There is no additional foci of parenchymal or leptomeningeal enhancement. Further evaluation with pre-and post enhanced brain MRI is recommended to exclude any additional lesions.Cortical sulci and ventricular system as well as gray -- white matter differentiation is within normal and with maintained midline.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells. Chronic postoperative changes of right orbit is again noted.No detectable calvarial or soft tissues of the scalp abnormality or enhancement. | 1.New single 6.5-mm superficially located left superior temporal gyrus (posteriorly) suggestive of a metastatic focus.2.Unremarkable pre-and post enhanced since prior exam. |
Generate impression based on findings. | Female 70 years old Reason: r/o malignancy vs. abscess History: perianal mass for 8mo ABDOMEN:LUNG BASES: Reticular pattern likely representing atelectasis/scarring.LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral hypodense renal lesions consistent with renal cysts.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: No evidence of obstruction or intraperitoneal free air.BONES, SOFT TISSUES: Mild degenerative changes of the thoracic spine.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: Thickened perianal region with induration and edema more prominent adjacent to the left gluteal cleft. No obvious discrete fluid collection.OTHER: No significant abnormality noted | Perianal induration and edema without discrete fluid collection. MR could be helpful to exclude an underlying mass. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of lymphoma and a maternal aunt 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 heterogeneously dense, which may obscure small masses. There is a focal asymmetry in the posterior left breast centrally. Additionally, there is asymmetry in the upper left breast posteriorly. No suspicious microcalcifications or areas of architectural distortion are present. | Focal asymmetry in the posterior left breast and asymmetry in the upper left breast for which comparison to prior studies should be made.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: OC - OLD FILM FOR COMPARISON |
Generate impression based on findings. | BRAIN: Subgaleal edema along the vertex of the scalp, best appreciated on the coronal series 81176, image 49. No underlying calvarial fracture is identified. There is thin right parietal subgaleal hyperdensity with mild overlying scalp fat stranding. No acute intracranial hemorrhage or CT evidence of acute large territorial ischemia. The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. Mastoid air cells are clear. Endotracheal tube is present. Partially visualized circular configuration catheter coiled in the oropharynx, presumably a nasogastric tube.MAXILLOFACIAL: There is a comminuted minimally displaced fracture of the right orbital floor with fracture extending through the infraorbital foramen; the inferior bony margin of the infraorbital foramen now extends caudally into the lumen of the maxillary sinus. The right inferior rectus muscle is thickened relative to the left, which may be related to edema and post traumatic deformity. There is herniation of a small amount of extraconal fat into the right maxillary sinus but no evidence of extraocular muscle entrapment. Marked right peri-orbital soft tissue swelling and air extending along the infero-medial preseptal soft tissues; the right globe and intraconal space appears preserved.Additionally, there is a comminuted and mildly inwardly displaced fracture of the anterior wall of the maxilla with evidence of an air-blood level within the right maxillary sinus. Comminuted, minimally displaced nasal bone fractures bilaterally. There is periapical lucency involving the right middle incisor. Mild mucosal thickening in the left maxillary sinus. | 1.No acute intracranial hemorrhage.2.Comminuted and minimally displaced fracture of the right orbital floor which extends through the infraorbital foramen as above, for which correlation with physical exam is recommended. The right globe and intraconal space appear preserved without evidence of extraocular muscle entrapment, although orbital fat does herniate through the defect.3.Comminuted fracture involving the right anterior maxilla as above with air-blood level within the right maxillary sinus. 4.Bilateral nasal bone fractures.5.Right middle incisor periapical lucency. Correlate for endodontal disease.6.Presumed nasogastric tube coiled within the oropharynx.Findings regarding NG tube relayed to Dr. Uchechi Oddiri over phone by Dr. Nimarta Singh At 1054 hours. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of left breast biopsy in 2002. Two standard digital views, additional bilateral MLO views, and tomosynthesis of both breasts 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. Biopsy clip is noted in the left mid inner breast. Benign appearing calcifications appear stable bilaterally. 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: NSC - Screening Mammogram. |
Generate impression based on findings. | Male 56 years old Reason: eval acute process History: abd pain, vomiting, recent UTI ABDOMEN:LUNG BASES: Bibasilar ground glass opacities suggestive of pneumonitis likely secondary to aspiration.LIVER, BILIARY TRACT: Hypodense subcentimeter lesions in the left hepatic lobe, which are unchanged and likely represent hepatic cysts. No biliary ductal dilatation.SPLEEN: Low-density focus in the medial aspect of the spleen (series 5, image 66, which is unchanged in size and likely benign in etiology.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left midpole exophytic kidney lesion unchanged in size measuring 1.2 x 1.2 cm (series 5, image 71), previously 1.2 x 1.2 cm. Without precontrast CT it cannot be ascertained if this is a high density cyst versus neoplasm. Continued attention to this area is recommended to exclude mass.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: G-tube unchanged position within the stomach. Gastric distention is present, similar to prior. Interval increase in colonic stool burden. There is a large amount of desiccated stool in the colon and rectosigmoid with focal focus of stool in the rectum measuring 8.1 x 6.1 cm (series 5, image 29). No evidence of free intraperitoneal air or discrete fluid collection.BONES, SOFT TISSUES: Diffuse subcutaneous anasarca/edema similar to prior.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Interval increase in stool burden with a large amount of desiccated stool in the rectum. No discrete fluid collection or intraperitoneal free air.2.New bibasilar ground glass opacities suggestive of pneumonitis which may be secondary to aspiration3.Diffuse anasarca, unchanged. |
Generate impression based on findings. | 59-year-old female with history of left-sided weakness. Head without contrast: There is no evidence of acute intracranial hemorrhage. There is moderate periventricular and subcortical white matter hypoattenuation compatible with age-indeterminate small vessel ischemic disease. The gray-white differentiation is preserved. The basal cisterns are intact. The imaged paranasal sinuses and mastoid air cells are clear. There are atherosclerotic calcifications of the imaged internal carotid arteries.Angiogram: The aortic arch is unremarkable. The left vertebral artery arises from the aortic arch, a normal variant. The cervical carotid arteries are unremarkable without evidence of flow limiting stenosis or aneurysmal dilatation. There is moderate scattered atherosclerotic disease of the intracranial vessels including bilateral internal carotid arteries, PICAs and right PCA. The ACOM and PCOMs are intact.Moderate to severe degenerative disc disease affects the cervical spine especially at C5-6. There are degenerative arthritic changes of the facets at C2-3, C3-4, and C4-5 with fusion of the facets on the right at C3-4. There is a slight cervical kyphosis. Biapical lung scarring and scattered pulmonary micronodules are present. There are scattered hypoattenuating thyroid lesions. | 1. Moderate intracranial atherosclerotic disease particularly of bilateral internal carotid arteries, bilateral PICAs and the right PCA.2. Moderate age-indeterminant small vessel ischemic disease.3. Moderate to severe degenerative disease affecting the cervical spine as above.4. Scattered hypoattenuating thyroid nodules. If patient care warrants further imaging, a dedicated thyroid ultrasound may be obtained.5. A new brain MRI was available at the time of dictation. |
Generate impression based on findings. | Alignment is anatomic. There are no acute fractures or subluxations. No evidence of spinal epidural hematoma as clinically questioned. The visualized paraspinal contents are unremarkable. Partially visualized marked bladder distention.T12/L1: No central spinal canal stenosis.L1/2: No central spinal canal stenosis.L2/3: No central spinal canal stenosis.L3/4: No central spinal canal stenosis.L4/5: Minimal disk bulge without central spinal canal stenosis.L5/S1: Minimal disk bulge without central spinal canal stenosis. | 1.No acute epidural hematoma as clinically questioned.2.No central spinal canal stenosis.3.Partially visualized marked bladder distention. |
Generate impression based on findings. | Reason: vascular malformation History: facial twitch Brain CTA: There is redemonstration of a 12 x 13 mm axial dimension and a 14 x 30 mm sagittal dimension extra-axial mass centered along the ventral aspect of the foramen magnum and abutting the odontoid and the clivus. The mass displaces the medulla posteriorly. The left vertebral artery courses over the posterior border of this mass and is partially encased by and hand subsequently drapes over the top of the mass. The mass abuts the vertebrobasilar junction and displaces the adjacent hypoplastic distal right vertebral artery which drapes over the mass. Compared to the prior exam from 6/17/13 the mass has increased in sagittal dimensions.The right PICA originates below the level of the mass.The left PICA originates along the distal aspect of the left vertebral artery.There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are intact.Atherosclerotic calcifications are present along the distal internal carotid arteries.CT head:There is redemonstration of a 12 x 13 mm axial dimension and a 14 x 30 mm sagittal dimension extra-axial mass centered along the ventral aspect of the foramen magnum and abutting the odontoid and the clivus. The mass displaces the medulla posteriorly. The left vertebral artery courses over the posterior border of this mass and is partially encased by and hand subsequently drapes over the top of the mass. The mass abuts the vertebrobasilar junction and displaces the adjacent hypoplastic distal right vertebral artery which drapes over the mass. Compared to the prior exam from 6/17/13 the mass has increased in sagittal dimensions.There is redemonstration of small hypodensities located in the basal ganglia and thalami and internal capsules left more than right as well is the brainstem and cerebellar hemispheres.Periventricular and subcortical white matter hypodensities of a moderate degree are present. This is stable when compared to the previous exam.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.Slowly enlarging extra-axial mass compatible with meningioma the level of foramen magnum. This mass abuts, partially surrounds and displaces the left vertebral artery. The mass abuts the vertebrobasilar junction and encases and displaces the adjacent hypoplastic distal right vertebral artery.2.Periventricular and subcortical white matter changes of a moderate degree are nonspecific. At this age they are most likely vascular related. 3.Lesions present in the basal ganglia, thalami, brainstem and cerebellar hemispheres are suspected to be related to prior vascular insults.4.No evidence for significant intracranial cerebrovascular stenosis. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of benign right excisional biopsy and left needle biopsy. 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 clip noted in the left upper outer breast. Circumscribed right lower outer breast mass appears benign and 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. | 75-year-old male patient status post laryngectomy with Provox valve in place and Barrett's esophagus. Evaluate motility. Scout radiograph of the chest showed no mediastinal widening, abnormal pulmonary opacities, or pleural effusions. Postsurgical changes are noted in the neck.Focused evaluation of the cervical esophagus demonstrated a voice prosthesis at the level of C5-C6 with passage of a small amount of barium through the tube, however, no leak was seen around the prosthesis during swallowing or on delayed images (cine series #4 and series 5, 6, 34, 35, 36). Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces. There was a mild nonobstructive narrowing at the cervicothoracic esophageal junction immediately distal to the Provox valve (series 23). During the exam, provoked gastroesophageal reflux was observed to the level of the hypopharynx. Fluoroscopic evaluation of esophageal peristalsis demonstrated cessation of the primary wave the level of the thoracic inlet with proximal escape, delayed secondary waves and tertiary waves predominantly in the distal half of the esophagus (cine series #26). There was stasis in the cervical esophagus with regurgitation.TOTAL FLUOROSCOPY TIME: 6:34 minutes | 1.Moderate to severe esophageal motility abnormality.2.No evidence of leak around Provox prosthesis.3.Provoked esophageal reflux to the level of the thoracic inlet. |
Generate impression based on findings. | Female; 73 years old. Reason: Assess progression of small cell carcinoma History: abdominal pain, delirium, biopsy proven small cell lung carcinoma in paraspinal mass. LUNGS AND PLEURA: Small left pleural effusion with overlying compressive atelectasis. No suspicious pulmonary nodules or masses. Minimal dependent atelectasis in the right lung.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Moderate coronary calcifications. Right chest port tip in SVC. Scattered calcified mediastinal and hilar lymph nodes are suggestive of prior granulomatous infection.CHEST WALL: Extensive bulky lymphadenopathy with many centrally necrotic lymph nodes, increased in size and appearing more confluent since the prior study. Lymphadenopathy extends from the left neck base (partially beyond the superior margin of this study) into the left axilla/chest wall and inferiorly into the retroperitoneum/abdomen. Reference left axillary lymph node now measures 38 mm in short axis, previously 25 mm, with increased central necrotic component. Left axillary vasculature is displaced but not significantly attenuated by these enlarged nodes. Minimal spinal degenerative changes. UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Please see separately dictated CT abdomen/pelvis report from same day for further details. | Interval progression of metastatic disease with extensive left neck base, left axillary, and retroperitoneal lymphadenopathy as described above. Please see separate CT abdomen/pelvis report for further details. |
Generate impression based on findings. | Reason: abnormal CXR, immunocompromised pt History: productive cough LUNGS AND PLEURA: Chronic interstitial scarring and traction bronchiectasis, with architectural distortion, compatible with sequela of a known prior history of ARDS.New right-sided central predominant patchy areas of peribronchial ground glass and small areas of consolidation. Scattered small foci of ground glass and nodularity at the left lung base are slightly decreased from the prior exam. Mild basilar bronchiectasis is present.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. No visible coronary artery calcifications. Hypoattenuation of the blood pool, compatible with anemia.No mediastinal or hilar lymphadenopathy.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Distended, fluid-filled stomach. Status post cholecystectomy | 1. New right-sided patchy areas of ground glass and consolidation, compatible with aspiration or atypical infection, including fungal and viral, in an immunocompromised patient.2. Underlying interstitial opacities and bronchiectasis consistent with a known prior history of ARDS. |
Generate impression based on findings. | Five month old male, chronic respiratory diseaseVIEW: Chest AP (one view) 2/24/15 8:14 Tracheostomy tube tip at the thoracic inlet. The cardiothymic silhouette is unchangedInterval increase in right lower lobe atelectasis on a background of chronic lung disease. No pneumothorax. | Increased right lower lobe atelectasis on a background of chronic lung disease. |
Generate impression based on findings. | 7-year-old male, rule out obstructionVIEW: Abdomen AP (one view) 2/23/15 18:50 The bowel gas pattern is nonobstructive. No evidence of bowel wall pneumatosis, portal venous gas or free intraperitoneal air. Small amount of feces is noted in the rectum. | Normal examination. |
Generate impression based on findings. | Postoperative changes of craniofacial reconstruction with barrel stave osteotomies with scattered extra-axial blood products and air. There is focal concavity of the osteotomies at the right frontal parietal region laterally. There is decreased prominence of the previously noted elongated skull morphology. No evidence of large parenchymal hemorrhage, edema, mass effect, or loss of gray white matter differentiation. Ventricles and sulci are normal in size and morphology. Re-demonstration of disconjugate gaze, with the left globe more laterally rotated than the right. | Expected postoperative changes of barrel stave osteotomies as above without large intraparenchymal hemorrhage. Improved calvarial contour. |
Generate impression based on findings. | 13-year-old female, post ankle, rule out fracture VIEW: Right ankle, AP, oblique, and lateral (3 views) 2/23/15 19:08 Alignment is anatomic. There is mild soft tissue swelling about the ankle. No fracture is evident. The ankle mortise is intact. | Mild soft tissue swelling without fracture or dislocation. |
Generate impression based on findings. | 63 years, Male. Reason: etiology of obstruction? History: rigid abdomen Enteric feeding tube tip projects over the antrum. Nonobstructive bowel gas pattern. Gallstones again noted projecting over the right upper quadrant. Patchy airspace opacities are again noted in the lower lungs. | Nonobstructive bowel gas pattern with enteric feeding tube tip projecting over the gastric antrum area. |
Generate impression based on findings. | Patient with graves to get uptake and scan for RAI dose calculation. History of hyperthyroidism. The thyroid images demonstrate an asymmetrically enlarged right thyroid lobe with uniform uptake. There is uniform uptake in the smaller left thyroid lobe. The 4-hour radioactive iodine uptake is 24% and the 21-hour uptake is 48% (normal range 10-30% at 24-hours). | Enlarged right thyroid lobe with increased uptake is consistent with Grave's disease; note the uptake value may be underestimated due to recent synthroid use. |
Generate impression based on findings. | Female 71 years old; Reason: r/o mass History: abd pain. bloating. hx prior SBO. hx colon cancer ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.BLADDER: Redemonstrated bladder diverticulum.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post partial colectomy. No obstruction. No free intraperitoneal air.BONES, SOFT TISSUES: Mild degenerative changes, most pronounced at L3-L4.OTHER: No significant abnormality noted. | 1.No CT findings of acute abdominal or pelvic pathology. |
Generate impression based on findings. | Female 50 years old Reason: 50yr old female with history of MM; post-auto sct evaluation History: evaluate. SKULL: Two views of the skull show innumerable punched-out lucent lesions of the calvarium, consistent with multiple myeloma.CERVICAL SPINE: Two views of the cervical spine show no focal lytic lesions. There is degenerative disk disease and mild cervical spine kyphosis, which appear similar to the prior study.THORACIC SPINE: Two views of the thoracic spine show the bones to be diffusely demineralized. Again seen is a compression fracture of T6, appearing similar to the prior study, with mild focal kyphosis at this level. There is also perhaps minimal loss of height at T7 that appears similar to the prior study.LUMBAR SPINE: Two views of the lumbar spine show the bones to be diffusely demineralized. There are compression fractures of L3 and L4 which appear similar to the prior study, as does a slight lumbar kyphosis and severe degenerative disk disease. There are no discrete myelomatous lesions. There is a slight leftward curvature of the lumbar spine.RIBS: Three views of the ribs show no focal lucent lesions. There appear to be healing fractures of the right fourth and the left fifth ribs, which were not present on the prior study.PELVIS: AP view of the pelvis shows the bones to be slightly demineralized. Small poorly defined lucencies in the left iliac wing may represent myelomatous deposits, but this is equivocal.UPPER EXTREMITY: Two views of the right humerus show lucent lesions in the proximal and mid-diaphysis consistent with multiple myeloma, appearing similar to the prior study. Two views of the left humerus show lucent lesions in the proximal and mid-diaphysis consistent with multiple myeloma, appearing similar to the prior study. AP views of bilateral forearms show poorly defined lucencies in the bilateral radial diaphyses which may represent myelomatous deposits, and are unchanged.LOWER EXTREMITY: Two views of the right femur show lucencies in the femoral neck and diaphysis consistent with multiple myeloma, some of which are better seen on the prior study. Two views of the left femur show a few poorly defined lucencies in the proximal femur that may represent myelomatous deposits, but this is equivocal and not appreciably changed from the prior study.Single AP view of the right tibia/fibula shows no discrete myelomatous lesions. Evaluation of the left tibia/fibula is limited by overlying cast material, but we see no discrete myelomatous lesions. | Findings consistent with multiple myeloma, appearing similar to the prior study. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. History of benign right breast biopsy in 2012. Sister with ovarian cancer at age 23 and breast cancer at age 34. 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. Biopsy clip noted in right upper outer 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. Given the patient's family history, breast MR as an additional screening tool should be considered. Referral to cancer risk clinic may also be of use. BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Emesis. NJ-tube placement. Liver transplant.VIEW: Abdomen AP (one view) 02/24/15, 0811 NG tube tip is at duodenojejunal junction. IVC stent continues in place. Postoperative changes of right upper quadrant are again seen. Central line tip is in right atrium. Biliary drain placed on 02/20/15 is in place.Bowel gas pattern is slightly disorganized. Few mildly dilated bowel loops are noted. Gas pattern is nonobstructive.Subsegmental atelectasis is seen in the bases. | No evidence of obstruction. |
Generate impression based on findings. | Male; 22 years old. Reason: Cough and fever in stem cell transplant pt; right LL opacity seen on radiograph, evaluate for viral vs bacterial infectious process History: Fever, cough. LUNGS AND PLEURA: Bronchial wall thickening, groundglass centrilobular nodules, and basilar consolidation with air bronchograms, left greater than right. Additional scattered areas of consolidation are also noted more superiorly in the right lung. Small bilateral pleural effusions. Findings are most suggestive of multifocal infection.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No significant mediastinal or hilar lymphadenopathy. Low density blood pool compatible with anemia. CHEST WALL: Diffuse anasarca.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Mild nonspecific free mesenteric fluid. | Findings compatible with multifocal pneumonia and diffuse endobronchial infection, most pronounced in the left lung base. Differential considerations include bacterial and atypical organisms given the patient's immune status. |
Generate impression based on findings. | 59 years, Male, Reason: evaluate hepatic architecture History: cirrhosis. LIVER: Liver is normal in size measuring 16.2 cm in length. Cirrhotic liver morphology with coarse echotexture. No focal hepatic lesions are evident. Portal venous flow is hepatopetal with a peak velocity of 0.2 m/sec. Portal venous flow is noted to be mildly pulsatile.GALLBLADDER, BILIARY TRACT: The gallbladder is nondistended. Multiple gallstones without gallbladder wall thickening or pericholecystic fluid. The common bile duct measures 5 mm in diameter.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 9.7 cm in length. No evidence of hydronephrosis or hydroureter. No shadowing caliculi or suspicious lesions evident.LEFT KIDNEY: The left kidney measures 9.7 cm in length. No evidence of hydronephrosis or hydroureter. No shadowing caliculi or suspicious lesions evident.SPLEEN: The spleen measures 13.5 cm in length.OTHER: Mild abdominal ascites and small bilateral effusions. | 1.Cirrhotic liver morphology without suspicious lesions evident.2.Cholelithiasis without evidence of cholecystitis.3.Mild splenomegaly.4.Small amount of ascites and small pleural effusions.5.Pulsatile portal venous flow may be seen in the setting of right heart failure. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. 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 almost entirely fatty, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | Breast cancer metastatic to iliac lymph nodes. On anti-estrogen therapy. Evaluate treatment response.RADIOPHARMACEUTICAL: 11.4 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 164 mg/dL. Today's CT portion grossly demonstrates an ovoid approximately 2 x 4 cm hypodense focus in the medial left breast. An approximately 2.5 cm triangular parenchymal density seen in the lingula with an approximately 1 cm more nodular focus at the right posterior lung base. Several borderline enlarged right iliac and obturator lymph nodes are noted. Extensive atherosclerotic including coronary arterial calcifications are present.Today's PET examination demonstrates near complete interval resolution of previous extensive markedly hypermetabolic right iliac lymph node metastatic activity. Mild residual activity at at several right internal iliac and obturator lymph nodes (SUV max = 9.2 previously, = 4.0 currently) may reflect inflammation or slight residual tumor metabolism.At the left lung base there is a new medium-sized triangular focus of markedly increased activity involving the lingula (SUV max = 7.1) which given the overall PET/CT appearance is considered most likely infectious/inflammatory. A similar although much smaller new mildly hypermetabolic focus is present at the posterior medial right lung base which is also more likely inflammatory.No additional suspicious FDG avid lesion is otherwise present. | 1.Marked metabolic response to therapy with near complete to complete interval resolution of previous hypermetabolic right iliac metastatic lymph node tumor activity. Slight residual right iliac activity may be inflammatory or minimal residual tumor uptake.2.Otherwise no convincing metastatic tumor activity. New bibasilar pulmonary activity particularly in the lingula is considered more likely inflammatory although attention to these regions on follow-up CT can be made to assure stability / resolution.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Reason: hx of lung Ca s/p pneumonectomy with infected space History: cough, weight loss LUNGS AND PLEURA: Status post left pneumonectomy with fluid opacification of the left hemithorax, slightly decreased in volume from the prior exam, with thickened pleura, increased from previous, with scattered pleural calcifications and a new nodular soft tissue focus measuring 1.5 x 1.3 cm (series 3, image 72) near the base of the left hemithorax.There are new small scattered areas of faint groundglass throughout the right lung, likely post-inflammatory in etiology, including aspiration.No suspicious pulmonary nodules or masses. No focal airspace consolidation or pleural effusions on the right.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. Mild coronary artery calcification.Scattered mildly prominent supraclavicular, mediastinal and hilar lymph nodes are unchanged. A right hilar lymph node measures 12 mm (series 3, image 50), not significantly changed.CHEST WALL: Postsurgical changes in the left hemithorax.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Persistent fluid opacification of the left hemithorax, with increased pleural thickening and nodularity, although there is no specific evidence of infection. |
Generate impression based on findings. | Right ankle fracture. Left ankle pain.VIEWS: Left ankle AP (one view), right ankle AP/lateral (two views) 02/24/15 In the single plane, the left ankle is normal in appearance. The tibial physis is fusing.The Salter-Harris 4 fracture of the right tibia has healed. The two screws remain in place. The tibial physis is fused. | Fused right tibial physis. Fusing left tibial physis. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Benign excisional biopsy of the left breast in 1975. Two standard digital views of both breasts 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. Scattered, benign morphology calcifications 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: NSC - Screening Mammogram. |
Generate impression based on findings. | History of ulcerative colitis abdominal painVIEWS: Abdomen supine and upright There is an ostomy at the right lower quadrant. Multiple surgical staples in the abdomen from prior surgery. Nonobstructive bowel gas pattern. No abnormal bowel dilation. No pneumatosis or pneumoperitoneum. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. 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. 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: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Comparison to the right footVIEWS: Left foot AP and lateral No acute fracture or dislocation. | Normal examination. |
Generate impression based on findings. | 17 year-old male with trauma with closed fist to face with tenderness to palpation along the right jaw. Evaluate for jaw fracture.VIEWS: Mandible Panorex (1 views) 2/23/2015 20:45 Mandible appears normal with no evidence of fracture or dislocation. | Normal examination. |
Generate impression based on findings. | Ms. Bales is a 62 year old female with a personal history of right breast lumpectomy in 1998 for IDC crate two followed by chemotherapy, radiation, and tamoxifen therapy. She has a personal history of benign left breast biopsy. Family history of breast cancer in paternal aunt. No current breast related complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the right breast. There are stable postsurgical changes including architectural distortion, increased density, and skin retraction present within the right lumpectomy site. A ribbon clip is identified in the left superior breast, at site of prior benign breast biopsy. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. Benign intramammary lymph node identified in the left lateral breast. | 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 41 years old; Reason: 41 yo female with greater than 2 months of abdominal pain and diarrhea and sterile pyuria. Please evaluate for signs of inflammation. History: abdominal pain, diarrhea ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Few scattered hypodensities, the largest measuring 1.6 cm, near the dome of the liver, probably cysts.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted. Corpus luteal cyst in the left ovary.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No bowel wall thickening or perienteric or pericolonic induration. No obstruction. No free intraperitoneal air. Trace free fluid is physiologic.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No acute abdominal or pelvic pathology. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. 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 almost entirely fatty, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSA - Screening Mammogram. |
Generate impression based on findings. | PainVIEWS: Right foot AP, oblique and lateral There is an acute transverse fracture involving the base of the fifth metatarsal with associated soft tissue swelling. The remainder of the examination is normal. | Fracture involving the base of the fifth metatarsal as described above. |
Generate impression based on findings. | Male; 56 years old. Reason: recurrent tongue cancer with neck mets History: r/o lung mets. LUNGS AND PLEURA: Scattered calcified and noncalcified micronodules without suspicious pulmonary nodules or masses. No pleural effusion or focal airspace opacity.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No significant mediastinal or hilar lymphadenopathy. Mild coronary calcifications. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. Cholecystectomy clips. | No evidence of metastatic disease. |
Generate impression based on findings. | 17-year-old male with tenderness along T3 - T4 status post blunt trauma. Evaluate for fracture.VIEWS: Thoracic spine AP, lateral and swimmers (3 views) 2/23/2015 Portions of the upper thoracic spine are obscured due to overlying anatomy on lateral and swimmer's views, however within this limitation, no discrete fracture or dislocation is noted. | No evidence of fracture or dislocation within the limitations noted above. |
Generate impression based on findings. | Reason: stroke History: left sided weakness There is redemonstration of encephalomalacia along the right parietal lobe.Periventricular and subcortical confluent white matter hypodensities of a moderate degree are present. The lateral ventricles are mildly enlarged.The patient is status post right parietal craniotomy.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction.3.Encephalomalacia is present along the right parietal lobe is unchanged compared to the prior exam.4.There are periventricular hypodensities present which are unchanged as the prior exam and suspected to be related to posttreatment change. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Personal history of colon cancer. Two standard digital views of both breasts and an additional right MLO 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. | 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: NSC - Screening Mammogram. |
Generate impression based on findings. | Female 43 years old Reason: lower back pain History: lower back pain. There is moderate to severe degenerative disk disease at L3/L4. The remaining intervertebral disk spaces appear normal and the vertebral body heights are preserved. Small osteophytes project from the anterior aspect of the lumbar vertebrae. There is a slight leftward curvature of the lumbar spine. | Degenerative disk disease. |
Generate impression based on findings. | Asymptomatic female presents for routine screening mammography. Two standard digital views of both breasts, additional bilateral MLO views, 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. Bilateral, circumscribed masses appear stable to prior exams and likely represent intramammary lymph nodes. Scattered, benign-morphology calcifications 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. | 13-year-old male with back pain, tenderness to palpation at T10. Evaluate for thoracic spine fractureVIEWS: Thoracic spine AP, lateral and swimmers (3 views) 2/23/2015 Alignment is normal. No evidence of fracture or dislocation. | Normal examination. |
Generate impression based on findings. | Reason: eval osteomyelitis and vascular insufficiency History: necrotic lesion on dorsum of R foot and fluctuance ABDOMEN:LUNG BASES: Small left pleural effusion noted. Bilateral basilar opacities compatible with aspiration or multifocal infection. ICD lead partially visualized. LIVER, BILIARY TRACT: Status post cholecystectomy. Reflux of contrast into the hepatic veins, suggestive of right heart failure.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Left renal hypodense lesion too small to characterize. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Asymmetric right adnexal enlargement (series 8 image 98). If clinically indicated pelvic ultrasound can be performed.BLADDER: Foley catheter in place.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Nonspecific right lower quadrant fat stranding.BONES, SOFT TISSUES: Degenerative disk disease of the spine. Bilateral hip osteoarthritis.OTHER: No significant abnormality notedLOWER EXTREMITIES:BONES, SOFT TISSUES: Soft tissue swelling of both lower extremities, right greater than left, most prominent over the dorsum of the right foot. No definite evidence of osteomyelitis. If high clinical suspicion MRI can be obtained.ANGIOGRAM:Abdomen/pelvis: Severe atherosclerotic disease of the aorta with calcified and noncalcified plaques throughout. There is chronic thrombus at posterior abdominal and thoracic aorta. Celiac artery is nearly completely occluded. Atherosclerotic plaques at proximal SMA and origin of the bilateral renal arteries. There is focal aneurysmal dilatation of infrarenal abdominal aorta measuring up to 3-cm extending into iliac vessels measuring 2 cm. Right lower extremity: There is complete occlusion of the native superficial femoral and popliteal arteries as well as femoral-popliteal graft. There is filling of the peroneal artery via unnamed collaterals from the deep femoral artery providing runoff to the foot. Arterial anatomy of the foot is not well delineated due to markedly slow flow.Left lower extremity: There is complete occlusion of the superficial femoral and popliteal arteries. There is at least segmental reconstitution of the peroneal artery. However, because of extensive delay in flow arterial anatomy cannot be clearly delineated. | 1.Severe atherosclerotic disease or the aorta and its branches. Complete occlusion of bilateral superficial femoral and popliteal arteries and right femoral-popliteal graft as above. 2.Soft tissue swelling of both lower extremities, right greater than left, most prominent over the dorsum of the right foot. No definite evidence of osteomyelitis. If high clinical suspicion MRI can be obtained.3.Bilateral basal patchy opacities compatible with multifocal infection or aspiration. Small left pleural effusion. 4.Nonspecific right lower quadrant fat stranding.5.Asymmetric right adnexal enlargement. If clinically indicated pelvic ultrasound can be performed. |
Generate impression based on findings. | 14-year-old male status post trauma with abdominal pain. ABDOMEN:LUNG BASES: Bibasilar atelectasis, left greater than rightLIVER, BILIARY TRACT: Normal appearance of the liver with no evidence of intra-or extrahepatic biliary ductal dilatation. Gallbladder is normal with no pericholecystic fluid.SPLEEN: Spleen is normal in appearance.PANCREAS: Normal with no pancreatic ductal dilatationADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Normal bilaterally with no evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal in caliber with no evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Foley catheter is noted in the bladder. Air in the bladder likely related to instrumentation.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal in caliber with no evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Bibasilar atelectasis with no evidence of pathology in the abdomen and pelvis. |
Generate impression based on findings. | Male 68 years old Reason: follow up History: follow up. We have 4 views of the left foot. The previously seen screws affixing the first tarsometatarsal joint have been removed and replaced with a plate and screw device affixing the first metatarsal to the first and second cuneiforms. We see no hardware complications. Periosteal reaction along the first metatarsal bone is nonspecific and may reflect healing.A plate and screw device affixing the second tarsometatarsal joint appears similar to that seen on the prior study, as does a screw affixing the third tarsometatarsal joint. Overall, the bones appear demineralized, perhaps from disuse, with persistent arthritic changes appearing similar to that on the prior study. There is dorsal soft tissue swelling. | Orthopedic fixation of Lisfranc joint as described above. |
Generate impression based on findings. | Male; 59 years old. Reason: History of tonsillar cancer. CHEST:LUNGS AND PLEURA: Bronchial wall thickening and mild upper lobe predominant centrilobular emphysema are again noted. No suspicious pulmonary nodules or masses. No pleural effusions or focal areas of consolidation.MEDIASTINUM AND HILA: No significant mediastinal or hilar lymphadenopathy. Normal heart size without pericardial effusion. Minimal coronary calcifications. Small hiatal hernia.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Small hypodensity in left liver lobe too small to characterize but stable and likely benign. Cholelithiasis.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Stable left upper pole renal cyst. No suspicious renal lesions or hydronephrosis. PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant retroperitoneal or mesenteric lymphadenopathy. Atherosclerotic calcification of the aorta and its major branches with unchanged narrowing of the proximal left common iliac artery.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastatic disease or significant interval change. |
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 heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. No suspicious masses, microcalcifications or areas of architectural distortion are present. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually.BIRADS: 1 - Negative.RECOMMENDATION: NSC - Screening Mammogram. |
Generate impression based on findings. | 55 years, Male, Reason: micro hematuria History: hematuria. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Diffuse fatty liver, most severe in the right hepatic lobe.SPLEEN: No significant abnormality notedPANCREAS: Hypodensity within the neck of the pancreas measures 0.6 x 0.7 cm (6/55). The pancreatic duct appears normal.ADRENAL GLANDS: Bilateral adrenal thickening.KIDNEYS, URETERS: No hydronephrosis. Bilateral subcentimeter hypodensities are too small to characterize but likely represent cysts. No suspicious renal lesions. No stones.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic calcifications of the aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Diffuse bladder wall thickening.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mild degenerative changes of the spine with posterior spinal fusion of L3-L5.OTHER: No significant abnormality noted | 1.Diffuse bladder wall thickening is nonspecific but may be seen in the setting of cystitis. No renal lesions or stones identified.2.Cystic lesion within the pancreas. Recommend MRCP for further evaluation. |
Generate impression based on findings. | 60 years, Male, Reason: HCV rule out cirrhosis History: HCV. LIVER: Liver is normal in size measuring 14.6 cm in length. Coarse hepatic echotexture without cirrhotic contour. No focal hepatic lesions are evident. Portal venous flow is hepatopetal with a peak velocity of 0.2 m/sec.GALLBLADDER, BILIARY TRACT: There is a large gallstone without gallbladder wall thickening or pericholecystic fluid. The common bile duct measures 8 mm in diameter.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 9.2 cm in length. No evidence of hydronephrosis or hydroureter. No shadowing caliculi or suspicious lesions evident.LEFT KIDNEY: The left kidney measures 11.6 cm in length. No evidence of hydronephrosis or hydroureter. A left renal peripelvic simple cyst measures 2.1 x 1.2 x 1.4 cm.SPLEEN: The spleen measures 8.5 cm cm in length.OTHER: No evidence of ascites. | 1.No focal hepatic lesions.2.Cholelithiasis without evidence of cholecystitis. |
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. There is a partially obscured mass in the left upper, outer breast at middle depth. No suspicious microcalcifications or areas of architectural distortion are present. | Mass in the left breast for which comparison to prior outside hospital studies is needed. BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: OB - OLD FILM FOR COMPARISON |
Generate impression based on findings. | 52 year old with history of benign bilateral breast biopsies. Known left benign mass and bilateral cysts. History of breast cancer in mother diagnosed at age 55 and paternal grandmother diagnosed at the age of 60. No new breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Stable 2 cm lobulated mass is present near the 12 o'clock position of the left breast. Benign calcifications are present bilaterally. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Ms. Braun submitted outside mammograms dated 05/6/2014 and 11/11/2009, from Advanced Medical Imaging Center. Submitted outside studies were compared to the current mammogram dated 02/05/2015. The breast parenchyma is composed of scattered fibroglandular elements. Scattered benign calcifications are present in both breasts. No suspicious masses, microcalcifications or areas of architectural distortion are present. There is no significant change between these two studies. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually, due next in Feb 2016.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | Male 75 years old Reason: r/o obstruction vs megacolon History: abdominal pain, positive c diff, worsening abdominal distension Limited examination secondary to lack of intravenous contrast. Evaluation of solid organs and vascular pathology is 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 significant abnormality notedRETROPERITONEUM, LYMPH NODES: Extensive atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Diffuse gaseous distention of loops of predominately large bowel. No evidence of obstruction, discrete fluid collection, or intraperitoneal free air. Mild gastric distention of the stomach is noted. Surgical changes from prior Nissen fundoplication.BONES, SOFT TISSUES: Degenerative changes of the thoracic spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of the lumbar spine.OTHER: No significant abnormality noted | Limited examination secondary to lack of intravenous contrast which makes evaluation of solid organs suboptimal. Within the limitations, there is diffuse mild dilatation of loops of predominately large bowel consistent which could represent either colonic ileus or megacolon. No evidence of obstruction or intraperitoneal free air. |
Generate impression based on findings. | right rib pain status post trauma. Evaluate for rib fracture.VIEWS: Bilateral ribs AP, right oblique and left oblique No evidence of fracture or dislocation. | Normal examination. |
Generate impression based on findings. | 58 years, Male, Reason: liver/biliary abnormality History: LFT abnormalities, abdominal pain. LIVER: Liver is normal in size measuring 17.4 cm in length. Hepatic echotexture is coarse and contour is cirrhotic. No focal hepatic lesions are evident. Portal venous flow is hepatopetal with a peak velocity of 0.2 m/sec.GALLBLADDER, BILIARY TRACT: The gallbladder is normal in appearance. No evidence of cholelithiasis, gallbladder wall thickening or pericholecystic fluid. The common bile duct measures 5 mm in diameter.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 12 cm in length. No evidence of hydronephrosis or hydroureter. No shadowing caliculi or suspicious lesions evident.LEFT KIDNEY: The left kidney measures 12.7 cm in length. No evidence of hydronephrosis or hydroureter. No shadowing caliculi or suspicious lesions evident.SPLEEN: The spleen measures 9.4 cm in length.OTHER: No evidence of ascites. | Cirrhotic liver without focal lesions evident. |
Generate impression based on findings. | Visualization of the thorax is limited by the field of view and length of scan, which excludes substantial areas of the lungs.CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Calcified lymph nodes compatible with previous infection.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: No significant abnormality noted. | No significant extra cardiovascular abnormalities in the visualized portion of the thorax. |
Generate impression based on findings. | 69 years, Male, Reason: 69 year-old male with findings on esophagram of possible esophageal varices. CT TRIPLE-PHASE OF LIVER requested to rule out cirrhosis and evaluate for possible varices History: as above. ABDOMEN:LUNG BASES: Reticular opacities, honeycombing and bronchiectasis in the bilateral lower lobes appears similar to the prior exam, compatible with UIP pattern. Severe coronary artery calcifications. Calcification along the right hemidiaphragm is unchanged.LIVER, BILIARY TRACT: Diffuse hepatic steatosis with areas of more focal fat deposition in the right hepatic lobe no esophageal varices are identified. Noncirrhotic contour. No suspicious hepatic lesions.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right upper pole hyperdense cyst is likely hemorrhagic/proteinaceous.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic calcifications of the aorta and its branchesBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Severe degenerative changes of the spine with grade 1 anterolithesis of L5 relative to S1OTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Degenerative changes of the spine.OTHER: No significant abnormality noted | 1.Hepatic steatosis without evidence of cirrhosis or esophageal varices.2.Fibrotic changes in the UIP pattern within the visualized lung are grossly unchanged. |
Generate impression based on findings. | 14 year old male status post trauma.VIEWS: Cervical spine AP and lateral (two views) 2/23/2015 23:04 NG tube coiled in the upper esophagus and nasopharyngeal airway. Limited evaluation of the cervical spine as only C1-C6 vertebrae are visualized on the lateral view. Evaluation for prevertebral soft tissue thickening is suboptimal due to tube position in nasopharyngeal airway. Within these limitations, there is no evidence of subluxation or fracture. | Within the limitations of the study, there is no evidence of subluxation or fracture. Recommend repeat radiograph for definitive evaluation. |
Generate impression based on findings. | 42 years, Female, Reason: of liver, hep b, screen for hcc History: same. LIVER: Liver is normal in size measuring 10.7 cm in length. Hepatic echotexture is coarse. No focal hepatic lesions are evident. Portal venous flow is hepatopetal with a peak velocity of 0.2 m/sec.GALLBLADDER, BILIARY TRACT: Sludge and small stones within the gallbladder without gallbladder wall thickening or pericholecystic fluid. The common bile duct measures two mm in diameter.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: The right kidney measures 10.7 cm in length. No evidence of hydronephrosis or hydroureter. No shadowing caliculi or suspicious lesions evident.LEFT KIDNEY: The left kidney measures 12.2 cm in length. No evidence of hydronephrosis or hydroureter. No shadowing caliculi or suspicious lesions evident.SPLEEN: The spleen measures 10.5 cm in length.OTHER: No evidence of ascites. | Coarse hepatic echotexture without focal lesions evident. Cholelithiasis. |
Generate impression based on findings. | Evaluate ET tubeVIEW: Chest AP 2/24/15 ET tube tip below thoracic inlet and above the carina. NG tube tip in the stomach. Right central line in place. Cardiothymic silhouette cannot be evaluated. Diffuse atelectasis bilaterally not significantly changed. No pleural effusion or pneumothorax. | Diffuse atelectasis bilaterally not significantly changed. |
Generate impression based on findings. | Reason: AIDS with abnormal CXR - further characterization; elevated amylase/lipase - r/o acute pancreatitis History: Left sided chest pain CHEST:LUNGS AND PLEURA: A large mixed-density, somewhat loculated left pleural effusion is new from the prior CT exam and prior radiograph dated 10/2014, with significant associated atelectasis/consolidation of the left lung. Dependent high density within the fluid collection is compatible with a component of hemorrhage. There is a questionable area of cavitation with surrounding high density, which is partially obscured by motion artifact (series 4, image 51). No significant mass effect on the mediastinum.Scattered pulmonary micronodules and mild dependent atelectasis in the right lung. Otherwise, the right lung is clear. No right sided effusion.MEDIASTINUM AND HILA: The heart is normal in size, without significant pericardial effusion. No visible coronary artery calcification. Hypoattenuation the blood pool, compatible with anemia.Nonspecific small lymph nodes in the upper mediastinum, likely reactive.CHEST WALL: Diffusely increased bony density, likely related to renal osteodystrophy.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: Bilaterally atrophic kidneys, with punctate calcifications and cysts.PANCREAS: No peripancreatic fat infiltration or fluid collection. Pancreatic vascularity cannot be assessed on noncontrast imaging.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1. A large mixed-density left pleural effusion contains a component of hemorrhage. A questionable cavitation in the underlying lung is incompletely evaluated on this exam.2. No specific CT evidence of acute pancreatitis. |
Generate impression based on findings. | Ms. Dowling is a 47 year old female with a personal history of left breast mastectomy in February 2013 for IDC treated with chemotherapy, radiation, and tamoxifen therapy. Personal history of benign right breast biopsy in 2013. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Rod shaped clip is seen in the right superior breast, at site of prior benign biopsy. Diffuse calcifications are identified in the right, many of which layer on the ML view, consistent with milk of calcium. There is no new mass, suspicious microcalcifications or areas of architectural distortion in the right breast. | Benign calcifications in the right breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, right unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 14-year-old male status post trauma.VIEWS: Pelvis AP (one view) 2/23/2015 23:02 No evidence of fracture or dislocation. | Normal examination. |
Generate impression based on findings. | 14-year-old male status post traumaVIEW: Chest AP (one view) 2/23/2015 23:50 NG tube tip coiled in the upper esophagus. ET tube below the thoracic inlet and above the carina.Cardiothymic silhouette is normal. No focal pulmonary. No pleural effusion or pneumothorax. No evidence of fracture or dislocation. | NG tube tip coiled in the upper esophagus. Otherwise no acute abnormality noted. |
Generate impression based on findings. | Muscle weakness. Question of malignancy. RADIOPHARMACEUTICAL: 11.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 82 mg/dL. Today's CT portion grossly demonstrates bibasilar pleural thickening/streaky linear opacities, right greater than left, along with a subpleural right lower lobe nodular density. There is a small right pleural effusion. There is centrilobular emphysema. The patient is status post cholecystectomy and gastrostomy tube placement. Foci of air within the bladder is presumably from recent instrumentation. Soft tissue stranding is noted in the abdominal/pelvic walls and upper thighs. Today's PET examination demonstrates a focus of hypermetabolic activity corresponding to a nodular density in the right lower lobe (max SUV = 6.2). There is minimal FDG uptake in the dependent portions of the lungs corresponding to streaky, linear opacities.There is diffuse heterogeneous uptake within the muscles.A focus of uptake corresponding to the gastrostomy tube is likely post-procedural.There is focal activity in the descending colon with SUVmax of 5.6 without a CT correlate. | 1.Focal uptake in the right lower lobe corresponding to a nodular density may represent infection or tumor. 2.Focal activity within the descending colon may represent normal GI activity, an adenoma, or carcinoma; correlation with history of colonoscopy is suggested. 3.Diffuse, heterogenous muscle uptake may be due to an inflammatory condition. |
Generate impression based on findings. | Female 67 years old; Reason: hx of bladder cancer, s/p radical cystectomy with indiana pouch urinary diversion, evaluate for metastatic disease History: see above ABDOMEN:LUNG BASES: Redemonstrated calcified mediastinal and hilar lymph nodes compatible with prior granulomatous disease. Stable pulmonary nodule measuring 7 mm along the right major fissure. Stable 3-mm pulmonary micronodule at the right lung apex. Multiple other stable intrapulmonary lymph nodes and micronodules and granulomas.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: Status post cystectomy with ileal conduit and pouch formation.LYMPH NODES: Stable left para-aortic lymph node measuring 1.5 x 1 cm (8:121)BOWEL, MESENTERY: Ovoid radiodensities in the large bowel, likely pills. No obstruction. Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted. Diastases of the rectus abdominis muscles.OTHER: No significant abnormality noted. | 1.No definite evidence of recurrent or residual disease. |
Generate impression based on findings. | 10-year-old female with concern for typhlitis or appendicitis ABDOMEN:LUNG BASES: Small left pleural effusion.LIVER, BILIARY TRACT: Pericholecystic fluid without adjacent inflammatory changes may relate to low albumin. No biliary ductal dilatation.SPLEEN: No focal lesion.PANCREAS: Normal pancreatic parenchyma.ADRENAL GLANDS: Normal adrenal morphology.KIDNEYS, URETERS: Symmetric renal cortical enhancement.RETROPERITONEUM, LYMPH NODES: No lymphadenopathy, free or loculated fluid collection.BOWEL, MESENTERY: The small bowel is normal in caliber. The colon is collapsed with mild diffuse wall thickening.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: Apparent wall thickening of the bladder may be due to under distention.LYMPH NODES: No lymphadenopathy.BOWEL, MESENTERY: The colon is collapsed with mild diffuse wall thickening. The small bowel is normal in caliber.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. Mild diffuse colonic wall thickening is nonspecific, but may represent diffuse colitis. No free or loculated fluid collection. 2. Small left pleural effusion. |
Generate impression based on findings. | Reason: 62 yo male with history of MDS; pre-allo SCT evaluation History: evaluate LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Moderate coronary calcificationsthe heart and pericardium otherwise unremarkable. No mediastinal or hilar lymphadenopathy noted. CHEST WALL: Mild degenerative changes affect the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | No significant abnormality. |
Generate impression based on findings. | 14-year-old female with history of left distal femur osteosarcoma, here for 9 months end of therapy evaluation to rule out lung relapse. LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. No pleural effusion or pneumothorax. MEDIASTINUM AND HILA: Normal sized heart with no pericardial effusion. No evidence of mediastinal or hilar lymphadenopathy.CHEST WALL: No evidence of axillary lymphadenopathy. No suspicious osseous lesions.UPPER ABDOMEN: No evidence of pathology in the visualized upper abdomen. | No evidence of metastatic disease to the chest. |
Generate impression based on findings. | Male 52 years old Reason: renal mass extending to ureter History: hematuria This study is severely limited due to lack of intravenous and oral contrast.ABDOMEN:LUNG BASES: Retrocrural adenopathy measuring 2.2 x 1.7 cm. this adenopathy is of uncertain etiology and significance. Small left pleural effusion.LIVER, BILIARY TRACT: Hepatosplenomegaly. Calcifications in the right lobe of the liver. Focal liver lesions cannot be excluded with this noncontrast CT.SPLEEN: Mild splenomegaly.PANCREAS: Pancreas is mildly diffusely enlarged. Lack of intravenous contrast limits optimal evaluation of the pancreas. Correlation with serum amylase and lipase levels is recommended to exclude acute pancreatitis.ADRENAL GLANDS: Diffuse thickening of the adrenal glands, unchanged from previous study.KIDNEYS, URETERS: Bilateral atrophic kidneys with multiple small hypodense lesions which cannot be optimally characterized with this noncontrast CT.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Interval decrease in the size of the left rectus sheath hematoma. Hematoma measures 3.8 x 2.4 cm on image number 120, series number 3.OTHER: Transplant kidney in the right iliac fossa with marked hydronephrosis. There is high density material within the renal pelvis of the transplant kidney extending into the ureter and into the bladder. Lack of intravenous contrast precludes optimal evaluation of this density. This may represent hemorrhage, debris, pus however, a neoplasm cannot be excluded. | Severe limited study due to lack of oral and intravenous contrast. Minimal interval decrease in the size of the left rectus sheath hematoma. Otherwise no significant change from previous study. High density material within the collecting system of the transplant kidney may represent blood, debris, plus or neoplasm.Diffusely enlarged pancreas. Correlation with serum amylase and lipase is recommended to exclude pancreatitis. |
Generate impression based on findings. | 78 year old female with DOE, assess for pulmonary fibrosis. Additional history of right breast carcinoma s/p lumpectomy in 2009. LUNGS AND PLEURA: Moderate dependent atelectasis/scarring. Mild bronchiectasis with possible traction and subtle ground glass opacities, best seen on prone views. There is mild subpleural reticulation but no definite honeycombing.Radiation changes in the right apex. Unchanged left upper lobe granuloma.MEDIASTINUM AND HILA: Heterogeneous thyroid with scattered cystic nodules. Normal heart size without pericardial effusion. Scattered calcified mediastinal and hilar lymph nodes compatible with prior granulomatous infection.CHEST WALL: Chronic postsurgical changes and fat necrosis in the right breast. Surgical clips in the right axilla. No axillary lymphadenopathy. UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Prominent gastrohepatic ligament lymph node measuring 9 mm on series 3, image 73. | 1.Mild bronchiectasis and subpleural reticulation with some surrounding ground glass opacity. Findings are nonspecific but suggest a possible NSIP pattern.2.Nonspecific 9 mm gastrohepatic lymph node, slightly more prominent compared to previous CT and for which continued interval follow-up can be considered. |
Generate impression based on findings. | Male, 75 years old, history of lung cancer, with headache. Several scattered hypoattenuating lesions are seen within the brain consistent with the patient's previously demonstrated parenchymal metastatic disease. Most of the smaller lesions seen on the prior MRI are not clearly resolved on the current examination due to differences in sensitivity between CT and MRI. However, at least one lesion within the posterior left parietal lobe has increased in size with some increase in the associated edema.No evidence of intracranial hemorrhage is seen. No significant generalized mass effect is detected. The ventricular system remains normal in size and morphology.Small nonspecific lucencies are seen within the right frontal bone. Suspected metastatic involvement of the right occipital condyle and adjacent mastoid temporal bone was better visualized on prior MRI. The paranasal sinuses and mastoid air cells are clear. | Interval increase in size of at least one lesion within the posterior left parietal lobe. Further evaluation with contrast-enhanced MRI is recommended. |
Generate impression based on findings. | Male 21 years old Reason: r.o fx History: s/p slip, fall on ice. point ttp over the proximal 5th metatarsal area. We see no fracture or malalignment or other findings for the patient's pain. | No fracture or malalignment. |
Generate impression based on findings. | Male 70 years old Reason: hx lumbar compression fractures, eval healing History: back pain. We have two views of the lumbar spine again showing compression fractures of L1 and L5. The L1 compression fracture appears similar to that seen on the November 2014 skeletal survey. There may have been slight interval progression of the deformity of the L5 vertebral body compared to the skeletal survey from November 2014, but this deformity appears comparable to that seen on the CT scan dated January of 2015. There also appears to be mild retropulsion of fracture fragments into the spinal canal, seen on the recent CT. | S1 and L5 compression fractures as described above. |
Generate impression based on findings. | 61 year old with history of left mastectomy in 2004 and reconstruction. No current breast complaints. Three standard views of the right breast were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is mostly fatty replaced. A benign intramammary lymph node is present in the posterior 9 o'clock position. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in right breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, right unilateral diagnostic mammogram is recommended annually. Patient will submit her old mammograms. Once they are available, current study will be compared to those old mammograms to establish stability. Results and recommendations were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Reason: Hx semisolid nodules on CT= One year follow up History: Cough. History of Sjögren syndrome. LUNGS AND PLEURA: Scattered peripheral, basilar predominant reticular interstitial opacities appear similar to the prior exam. Mild traction bronchiectasis.A previously referenced right upper lobe pleural based nodule measures 6 x 4 mm (series 4, image 33), unchanged. Additional scattered micronodules, some calcified, are unchanged. No new suspicious pulmonary nodules or masses.No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size without pericardial effusion. Moderate coronary artery calcification.Mediastinal and hilar lymphadenopathy, similar in appearance to the prior exam. Reference AP window lymph node measures 1.6 cm (series 3, image 55), not changed from the prior exam accounting for differences in measurement technique.CHEST WALL: Degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Punctate nonobstructing renal calcifications are again seen. | 1. Stable mild reticular interstitial disease with mild traction bronchiectasis, likely related to underlying connective tissue disorder. 2. A reference 6-mm right upper lobe pleural based nodule is stable from 02/2014, compatible with scarring or prior inflammation, and is no longer regarded as suspicious.3. Unchanged mediastinal lymphadenopathy. |
Generate impression based on findings. | Female 80 years old Reason: follow up History: follow up. Three views of the left ankle show a plate and screw device affixing a fracture of the distal fibula in near-anatomic alignment. A small amount of callus formation along the posterior margin of the fracture suggests some interval healing.A linear density along the medial malleolus may represent a retinacular avulsion, but this is equivocal and unchanged from the prior studies. Ankle joint alignment is within normal limits. | Orthopedic fixation of healing distal fibular fracture. |
Generate impression based on findings. | Male 77 years old Reason: Metatstatic melanoma, s/p ipilimumab. Evaluate disease burden History: Fatigue CHEST:LUNGS AND PLEURA: Scattered micronodules are unchanged.MEDIASTINUM AND HILA: Left thyroid nodule is unchanged. It measures 3.4 x 2.6 cm on image number 12, series number 3. Index right hilar node measures 2.2 by 1.9 cm on image number 41, series number 3, minimally decreased compared to previous study. However there is new mediastinal adenopathy measuring 3 .5 by 3.7 cm on image number 31, series number 3.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral cysts are unchanged. Some of these cysts are complex.RETROPERITONEUM, LYMPH NODES: Small retroperitoneal lymph nodes are unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | New mediastinal metastatic adenopathy. Slight interval decrease in the size of the right hilar lymph node. Otherwise no significant change from previous study. |
Generate impression based on findings. | 55 year old with history of stereotactic core needle biopsy for calcifications with results of minimally focal ADH. No current breast complaints. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is composed of scattered fibroglandular elements, unchanged in pattern and distribution. Two biopsy clips are present in the central right breast, posterior depth. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in either breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, bilateral diagnostic mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Female, 49 years old s/p colonic stent removal. RFO Trigger: Look for evidence of stent material in left hemiabdomen. Suspected RFO Location: Left hemiabdomen. Suspected RFO: Stent material No unexpected radiopaque foreign bodies. Surgical clamp projects over the right hemiabdomen believed to be external to the patient. Additional partially visualized radiopaque object in the upper abdomen, presumed to be external to the patient. Surgical clips project over the left hemiabdomen. Interval removal of a colonic stent with no evidence of residual stent material. Nonobstructive bowel gas pattern. | No unexpected radiopaque foreign bodies. Findings were discussed with attending surgeon, Dr. Roggin, over phone, at 1040 on 2/24/15. |
Generate impression based on findings. | Female 56 years old Reason: spondylosis? History: LBP. There is moderate degenerative disk disease at L4/L5 and L5/S1. There is moderate to severe facet joint osteoarthritis affecting the lower lumbar levels with a grade one anterolistheses of L4 and L5. Vertebral body heights are preserved. A right total hip arthroplasty is incompletely imaged on this study. | Degenerative disk disease, facet joint osteoarthritis and anterolistheses as described above. |
Generate impression based on findings. | 12-year-old male with flatfoot.VIEWS: Right and left foot AP and lateral (4 views) 2/24/2015 10:10 Bilateral pes planus. No evidence of fracture or dislocation. No soft tissue swelling or joint effusion. | Bilateral pes planus. |
Generate impression based on findings. | Male 65 years old Reason: R/o separated shoulder/Dislocation History: Pain on abduction . There is mild osteoarthritis of the glenohumeral and acromioclavicular joints. There is a mineralization along the greater tuberosity consistent with calcific subdeltoid bursitis, more prominent on the current study than on the prior study. We see no fracture or dislocation and the acromioclavicular joint alignment is within normal limits. | Mild osteoarthritis and findings consistent with calcific bursitis as described above. |
Generate impression based on findings. | 51-year-old male with history of syncope and headache. There is no evidence of acute intracranial hemorrhage. There is a focus of hypoattenuation measuring 8 x 5 mm within the medial aspect of the right superior temporal gyrus which is nonspecific but appears to measure fluid density. The gray-white differentiation is preserved. The ventricles and sulci are symmetric, normal for age. The basal cisterns are intact. There is a chronic concave deformity of the left lamina papyracea. The orbits are otherwise unremarkable. The mastoid air cells are clear. | 1. No acute intracranial abnormality.2. Nonspecific focus of fluid density within the medial aspect of the right superior temporal gyrus, just superomedial to the right temporal horn. A nonemergent MRI is recommended for further evaluation, to evaluate possible cystic lesion and to exclude neoplasm. |
Generate impression based on findings. | Female 56 years old; Reason: pancreatic neuroendocrine tumor with slight pd on previous scan. evaluate for interval change History: neuroendocrine tumor CHEST:LUNGS AND PLEURA: Scattered, stable nonspecific noncalcified lung micronodules. Stable 4-mm groundglass nodule in the right lower lobe (9:58) and left upper lobe (9:25).MEDIASTINUM AND HILA: Mild coronary calcifications.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy. No ductal dilatation.SPLEEN: No significant abnormality noted.PANCREAS: Previously seen mass in the head and body and likely uncinate process of the pancreas measured 6.8 x 2 .4 cm, and is difficult to obtain a similar measurement based on the orientation of the slices on today's exam. However, a large component of the mass in the body and tail previously measured 4.2 x 1.9 cm (6:38), and is grossly stable, now measuring 4.2 x 2.0 cm (6:44). Redemonstrated pancreatic ductal dilatation and atrophy of the pancreatic tail.ADRENAL GLANDS: Stable bilateral adrenal thickening.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Patent celiac, SMA, IMA, and splenic arteries. Proximal splenic artery is encased by tumor. Patent splenic vein up to the confluence. The tumor abuts the immediate confluence of the splenic vein, superior mesenteric vein and portal vein (7:105), similar in prior appearance.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Status post hysterectomy.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.Grossly stable pancreatic body mass and in involved vasculature accounting for slight differences in technique between both CT scans, as described above. |
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