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Generate impression based on findings. | Female 46 years old Reason: eval for arthritis, pes planovalgus History: L dorsal midfoot pain. We have 3 views of the left ankle. Small osteophytes along the tibiotalar joint indicate mild osteoarthritis. A poorly defined lucency in the medial aspect of the talar dome may represent a degenerative cyst or old osteochondral defect. There is opacification of the pre-Achilles fat, likely representing an accessory soleus muscle.We have 3 views of the left foot. There is a mild pes planovalgus deformity as well as mild osteoarthritis affecting the midfoot. | Mild pes planovalgus deformity and osteoarthritic changes as described above. |
Generate impression based on findings. | Distal femoral osteosarcoma. End of therapy evaluation.VIEWS: Left femur AP/lateral (two views) 02/24/15 Longstem total knee endoprosthesis device is again visualized. No loosening is identified. The proximal femur is normal in appearance.Soft tissue fullness is present in the popliteal region and unchanged from 08/19/14. This is most likely related to knee flexion. High density linear structures are present in the popliteal region and are probably surgical clips. | No definite evidence of tumor recurrence. A lateral knee radiograph in extension is recommended for evaluation of the popliteal soft tissue fullness. |
Generate impression based on findings. | Reason: Abscess, signs of ludwig's? History: neck swelling, edema The right submandibular gland is asymmetrically enlarged when compared to the left. There is mild infiltration of surrounding fat planes in the right submandibular space. There is no evidence for radiopaque sialolith. The right jugulodigastric node that is asymmetrically larger when compared to the left appear to have submental node measures 14 x 17 mm axial dimensions.Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland appears intact.The airway appears patent.The visualized intracranial structures which include the posterior fossa are intact. The visualized portions of the orbits are intact. The paranasal sinuses are clear. The mastoid air cells are clear.The parotid and the submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis. | 1.Findings suggest sialadenitis involving the right submandibular gland associated with some reactive adenopathy. Please correlate with patient's clinical history and symptoms. If the patient does not have corresponding clinical symptoms suggestive of inflammatory change, alternates considerations may include lymphadenopathy. |
Generate impression based on findings. | Weight loss, diarrhea. Question of carcinoid tumor recurrence. Normal physiologic radiotracer distribution is seen in the salivary glands, myocardium, liver, bowel and bladder. There is no abnormal focus of activity to indicate current MIBG avid tumor.A sclerotic focus within the right ilium adjacent to the SI joint is again noted. | No evidence of a somatostatin receptor avid tumor; the questionable subcentimeter liver lesions seen on recent CT are beyond the resolution of SPECT/CT. |
Generate impression based on findings. | 72-year-old male with shortness of breath and fatigue, preoperative evaluation for MVR/TVR. ANGIOGRAM: Please see accompanying cardiac CT report for description of thoracic aorta. There is no evidence of abdominal aortic aneurysm, dissection, or significant stenosis. The origins of the great vessels, celiac axis, SMA, and renal arteries are patent. Mild to moderate atherosclerotic disease affects the abdominal aorta and its branches. A segment of mural thrombus/plaque is present in the distal aorta and extends into the right common iliac artery which narrows the lumen of the proximal right common iliac artery to approximately 8 mm. There is no significant tortuosity or circumferential atherosclerotic calcifications of the common/external iliac arteries. VESSELS:SUPRARENAL ABDOMINAL AORTA: 3.0 x 2.7 cmINFRARENAL ABDOMINAL AORTA: 2.1 x 2.0 cmRIGHT COMMON ILIAC ARTERY: 14.6 x 15.5 mmRIGHT EXTERNAL ILIAC ARTERY: 10.0 x 9.7 mmRIGHT COMMON FEMORAL ARTERY: 8.6 x 8.9 mmLEFT COMMON ILIAC ARTERY: 14.2 x 13.8 mmLEFT EXTERNAL ILIAC ARTERY: 9.6 x 9.6 mmLEFT COMMON FEMORAL ARTERY: 8.7 x 8.7 mmABDOMEN:LUNG BASES: Please see accompanying cardiac CT report for description of pulmonary findings. LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Macroscopic fat containing left renal nodule (series 6, image 111) compatible with benign adrenal myolipoma.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. Postsurgical changes of partial right colectomy. BONES, SOFT TISSUES: Moderate degenerative changes of the visualized thoracolumbar spine. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. Postsurgical changes of partial right colectomy. BONES, SOFT TISSUES: Moderate degenerative changes of the visualized thoracolumbar spine. OTHER: Left fat-containing inguinal hernia. | 1.Vascular measurements of the abdominal aorta and its branches as above. Please see dedicated cardiac CT for details regarding the chest and thoracic aorta.2.Mild-moderate atherosclerotic disease of the abdominal aorta and its branches including mural thrombus which narrows proximal right common iliac artery to approximately 8 mm. No significant tortuosity of common/external iliac arteries.3.Enlarged prostate. |
Generate impression based on findings. | 49 year-old female with history of DCIS status post left mastectomy in 2008, chemotherapy, and radiation therapy, and history of benign right axillary lymph node biopsy in 2009. . 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 composed of scattered fibroglandular elements, unchanged in pattern and distribution. A cluster of calcifications in the right breast anterior 12 o'clock position has decreased in size and number. No suspicious mass, suspicious microcalcifications or suspicious areas of architectural distortion are noted in right breast. A biopsy clip is present in a right axillary lymph node. | No mammographic evidence of malignancy. As long as the patient's physical examination remains unremarkable, right 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. | Age: 80 years. Sex : Male. Reason for study: Reason: 80 male with AML, prior CVA. Concern for clinical aspiration History: Coughing. Fluoroscopic guidance was provided for an oropharyngeal motility study performed by the Speech Pathology section of the ENT service. The examination was recorded on videotape. No static or hard copy films were obtained. The exam was positive for penetration and positive for aspiration. FLUOROSCOPY TIME: 3 minutes | The exam was positive for penetration and positive for aspiration. Please see speech pathology report for additional findings and feeding recommendations. |
Generate impression based on findings. | Female, 23 years old, status post tumor resection. Findings are seen compatible with recent left occipital craniotomy and resection of tumor from the left cerebellar hemisphere. A resection cavity is present within the left cerebellum containing largely hypoattenuating fluid but with a few small areas of hyperattenuation likely representing blood product. The left cerebellar tonsil continues to herniate below the level of the foramen magnum. Intracranial air is seen, an expected finding. The craniotomy defect has been repaired with mesh.Outside of the cerebellum, no significant parenchymal abnormality is detected. No edema, mass effect or loss of gray-white distinction is noted. The ventricular system is stable and normal in size.The osseous structures of the calvarium are remarkable only for the left occipital surgical findings and an old right frontal burr hole. The visualized paranasal sinuses and mastoid air cells are clear. | Expected findings status post tumor resection from the left cerebellar hemisphere. |
Generate impression based on findings. | 58 years, Male. Reason: bilious emesis, placement of NJT and OGT History: as above Bilateral pleural effusions.There a naso- jejunal feeding tube with tip projected far beyond the ligament of Treitz, over the right lower quadrant. Interval insertion of a second enteric feeding tube. The tip is projected over the proximal gastric body. Cystogastrostomy stent is again noted and projected over the gastric body. Nonobstructive bowel gas pattern. | Interval insertion of a second enteric feeding tube with tip projected over the proximal gastric body. |
Generate impression based on findings. | 24-year-old male with VHR pre-B cell ALL now with productive cough and crackles on exam.VIEWS: Chest PA/lateral (two views) 2/24/2015 10:43 Right upper extremity PICC tip in the right brachiocephalic vein.Cardiac silhouette is normal. No focal pulmonary opacities. Linear streaky retrocardiac opacity likely atelectasis. No pleural effusion or pneumothorax. | Atelectasis in the left lung base with no evidence of pneumonia. |
Generate impression based on findings. | Reason: H\T\N cancer in follow-up CT neck:The right sternocleidomastoid muscle is atrophic and the right jugular vein is absent. There is infiltration of the fat planes surrounding the right carotid space. Some mild atherosclerotic narrowing is present at the distal right common carotid arteryWithin the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland appears intact.Within the the trachea at the level of the thoracic inlet there is a 5 x 10 mm coronal dimension opacity present which was not present on the prior exam. It is adjacent to the right posterior aspect of the ventricular wall. Density characteristics suggest this may represent secretions.The parotid and the submandibular glands appear intact.The visualized lung apices appear clear.The carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis.There is redemonstration of a periapical lucency along the right maxillary molar which appears to have been present on the prior exam.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No acute intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses demonstrate mucosal thickening in the right maxillary sinus and a minor opacity in the left frontal sinus with air fluid level in the right maxillary sinus. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for local recurrence or neck lymphadenopathy on the basis of CT size criteria for lymphadenopathy. There are infiltrative changes in the right neck which are suspected to be postsurgical in nature and have been stable since prior exams.2.Opacity in the trachea is suspected to represent secretions .3.An opacity in the right maxillary sinus could represent retained secretions or acute sinusitis.4.No evidence for brain metastases. |
Generate impression based on findings. | Male 66 years old Reason: clincial trial patient,please give bi-dimensional measurements History: hx of metastaic prostate cancer CHEST:LUNGS AND PLEURA: Right apical scarring and emphysema.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Bilobar large cystic lesions in the liver are unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Bilateral adrenal adenomas are unchanged.KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: T10 sclerotic focus is unchanged.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Index left femoral lymph node is unchanged measuring 1.7 x 1.1 cm image number 180, series number 4.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Sclerotic foci in the left iliac wing, unchanged.OTHER: No significant abnormality noted | No significant change from previous study. |
Generate impression based on findings. | 13-year-old male with fracture.VIEWS: Right humerus AP and lateral (two views) 2/24/2015 10:46 Healing fracture through a lucent lesion in the proximal humeral metaphysis which is in near-anatomic alignment. Periosteal reaction is noted in the proximal humerus | Healing pathological fracture involving the proximal humerus. |
Generate impression based on findings. | 53-year-old female with history of chronic sinusitis. There is minimal mucosal thickening along the inferior aspect of the right maxillary sinus. There is periapical lucency surrounding the right second maxillary molar. The remaining paranasal sinuses are clear. The ostiomeatal complexes, frontoethmoidal, and sphenoethmoidal recesses are patent. The lamina papyracea are intact laterally. The orbits are normal. There is mild rightward deviation of the nasal septum. Septal perforation noted.The visualized intracranial structures are unremarkable. There is partial opacification of the air cells involving the petrous apex without expansion. There is subtle osseous dehiscence superiorly. The mastoid air cells and middle ears are clear. | 1. Mild mucosal thickening involving the inferior right maxillary sinus which may be odontogenic in origin given periapical lucency of adjacent right second maxillary molar tooth. Paranasal sinuses are otherwise clear.2. Rightward nasal septal deviation and small septal perforation.3. Opacification of few air cells involving the left petrous apex may be due to trapped fluid. There is however subtle osseous erosion/dehiscence superiorly raising possibility of other etiologies. No osseous expansion. Consider dedicated temporal bone MRI/CT for further evaluation. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Male 36 years old Reason: Evaluate for progression History: Kaposi's sarcoma CHEST:LUNGS AND PLEURA: Bilateral bronchial wall thickening with new small ground glass opacity in the right lower lobe likely secondary to aspiration bronchiolitis. Volume loss, atelectasis and traction bronchiectasis of the right middle lobe, unchanged which may be secondary to chronic mucous plugging. Mild paraseptal emphysema.MEDIASTINUM AND HILA: Slight interval increase in size of mediastinal lymph nodes. Reference low right paratracheal lymph node measures 1.1 cm in short axis (series 3, image 32), previously 0.9 cm.CHEST WALL: Increased bilateral axillary and subpectoral lymphadenopathy.ABDOMEN:LIVER, BILIARY TRACT: No biliary duct dilatation or focal hepatic mass. Hepatic vasculature is patent.SPLEEN: Stable splenomegaly now measuring 13 cm in length (series 3, image 88).PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Heterogeneous lesion in the inferior pole of the right kidney is similar in size measuring approximately 4.5 by 2.9 cm (series 3, image 120), previously measuring 4.8 x 2.9 cm. New intraluminal filling defect within the right renal vein best seen on coronal images (series 80244, image 47) consistent with renal vein thrombosis. Bilateral nonobstructing renal calculi, unchanged.RETROPERITONEUM, LYMPH NODES: Relatively unchanged retroperitoneal lymphadenopathy with reference left para-aortic lymph node measuring 1.3 x 1.6 cm (series 3, image 115), previously 1.1 x 1.6 cm.BOWEL, MESENTERY: Colonic diverticulosis without evidence for diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Stable pelvic lymphadenopathy with reference right internal obturator node now measuring 1.2 x 2.0 cm (series 3, image 177), previously 1.4 x 2.4 cm.BOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality noted OTHER: No significant abnormality noted | 1.Heterogeneous right renal mass with new vascular involvement. These findings are atypical for lymphoma and favor other malignant etiology. If definitive diagnosis will affect the patient's clinical management, recommend percutaneous renal biopsy for further catheterization. 2.Worsening bronchial wall thickening and basilar ground glass opacity likely representing aspiration bronchiolitis. 3.Interval worsening of axillary and mediastinal lymphadenopathy with stable retroperitoneal and pelvic lymphadenopathy.4.Persistent right middle lobe airspace opacity with atelectasis, bronchiectasis and nodularity, without significant change. |
Generate impression based on findings. | Male 82 years old Reason: gastric cancer resected 2010 evalaute for disease development History: gastric cancer CHEST:LUNGS AND PLEURA: Stable micronodules.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Ill-defined new hypodensity adjacent to the clip in the left lobe of the liver measuring 8 x 9 mm in image number 95, series number 3. The etiology is unknown. MRI of the liver may be helpful for better characterization of this lesion. Diffuse fatty infiltration of the liver.SPLEEN: No significant abnormality notedPANCREAS: Atrophic pancreas.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Status post gastrectomy. Paraumbilical hernia containing nonobstructed small bowel loops.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 subcentimeter liver lesion adjacent to the clips in the left lobe of the liver. MRI of the liver may be helpful for further characterization of this lesion. Otherwise no significant change from previous study. |
Generate impression based on findings. | Reason: multiple small nodules, TNTC. Please eval compared to old images. has had 2 TBBx that are non-dx History: weight loss LUNGS AND PLEURA: Mild centrilobular emphysema.Innumerable subcentimeter ground glass nodules of varying sizes throughout the lungs. There is suggestion of cavitation within a majority of these lesions on thin section imaging. Direct comparison to prior imaging is difficult due to the small size of the large number of the nodules. For reference, a left upper lobe nodule measures 8 x 6 mm (series 4, image 34; comparing with CT chest dated 1/6/ 2015, series 2, image 22), unchanged. A right lower lobe nodule measures 8 x 8 mm (series 4, image 68; comparing with CT chest dated 1/6/2015, series 2, image 40), unchanged.Atelectasis in the medial segment of the middle lobe, similar to the prior exam.Small right effusion, persistent from the prior PET exam dated 02/05/2015.MEDIASTINUM AND HILA: Moderate pericardial effusion. The main pulmonary artery is enlarged, suggestive of pulmonary hypertension. Moderate coronary artery calcification. Severe atherosclerotic calcification of the thoracic aorta and its branches.No mediastinal or hilar lymphadenopathy. Hilar lymph nodes are difficult to evaluate on noncontrast imaging.CHEST WALL: Degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Atherosclerosis of the abdominal aorta and its branches. | 1. Innumerable subcentimeter ground glass nodules of varying sizes throughout the lungs, grossly similar to the prior exam dated 01/2015, although direct comparison is difficult. Probable cavitation in a majority of these lesions. Differential considerations include disseminated infection, particularly granulomatous infections, including fungal etiologies, and metastases.2. Small right pleural effusion and moderate pericardial effusion. |
Generate impression based on findings. | 55-year-old female. Metastatic lung cancer. Brain mets status post 1 line of therapy. Compare to previous study and evaluate disease status. LUNGS AND PLEURA: Right lower lobe mass measures 5.9 x 3.8 cm, previously 3.9 x 3.4 cm (series 6, image 85). Additional nodules in the right lung also appear increased since the prior study. For example, subpleural right lower lobe ground glass nodule measures 6 mm, previously 5 mm (series 6, image 55). 14 mm nodular opacity in right apex was not clearly visualized on the previous CT (series 6, image 16). Postoperative changes of left upper lobectomy with associated fibrosis and volume loss. Loculated small left apical pneumothorax with associated pleural thickening and probable bronchopleural fistula unchanged.MEDIASTINUM AND HILA: Normal heart size with small pericardial effusion. Scattered small mediastinal lymph nodes, not enlarged by CT size criteria. No hilar lymphadenopathy.CHEST WALL: Healed left rib fractures. No axillary lymphadenopathy.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Scattered hepatic hypodensities are again noted, most likely cysts. | 1.Interval increase in size of right lower lobe mass, likely primary lung neoplasm.2.Interval increase in size and number of right lung nodules, suspicious for metastatic disease. |
Generate impression based on findings. | There is trace mucosal thickening extending into and opacifying the left frontoethmoidal recess. There is trace left maxillary sinus mucosal thickening. The ostiomeatal complexes are otherwise patent. The remaining paranasal sinuses are clear. There is no air-fluid level or bubbly secretions within the paranasal sinuses. The nasal septum is deviated to the right. There is a right osseous spur opacifying the right middle meatus and in close proximity with the right inferior and middle turbinates. More posteriorly, there is a left septal osseous spur impinging upon the left middle turbinate. | Trace mucosal thickening as described above. Otherwise no significant paranasal sinus disease. |
Generate impression based on findings. | 42 year old with left breast pain. Family history of breast cancer in her maternal grandmother and 3 paternal aunts. Patient has a history of benign biopsied fibroadenoma in the right breast. 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. Again seen is a biopsy clip in the retroareolar right breast. 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 normal, bilateral screening mammogram is recommended annually. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | 63 years, Male, Reason: 63 yo male with hx of mesenteric mass; please evaluate for abnormalities History: mesenteric mass. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Punctate nonobstructing stone in the right mid kidney. Resolution of right UVJ stone. Bilateral renal cysts are unchanged. No hydronephrosis.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Soft tissue mass with calcifications in the mesentery measures 2.9 x 1.7 cm (4/64), previously 3.2 x 1.8 cm.BONES, SOFT TISSUES: Mild degenerative changes of the visualized spine.OTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Calcific mesenteric mass is stable. |
Generate impression based on findings. | Female 63 years old; Reason: mETASTATIC RECTAL CANCER TO VULVA ON CHEMOTHERAPY HOLIDAY. eVALUATE FOR DISEASE PROGRESSION History: RECTAL CANCER CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Right chest wall port with tip in the right atrium.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Small hiatal hernia.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted. Vulva is incompletely visualized.BLADDER: No significant abnormality noted.LYMPH NODES: Partially calcified left inguinal nodes previously measure 3.8 x 2 .6 cm, now measuring 4.4 x 2.6 cm (3:185). A left internal obturator node measures 3.1x1.9cm, previously measuring 3.2 x 1.9 cm. Stable enlarged right femoral node. Two previously seen less than 4-mm right inguinal nodes have significantly increased in size, now measuring 1.2 and 8 mm, respectively (3:185). Couple other right inguinal nodes also appear more enlarged (3:177).BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Interval increase in right inguinal lymphadenopathy as described above. |
Generate impression based on findings. | No acute intracranial hemorrhage or evidence of mass, mass-effect, or midline shift. Extensive chronic white matter disease and parenchymal volume loss is unchanged compared to the previous examination and consistent with multiple sclerosis. The visualized portions of the paranasal sinuses and mastoid air cells are clear. | 1.No acute intracranial hemorrhage or CT evidence of a mass as clinically questioned.2.Significant chronic white matter disease and volume loss is unchanged and consistent with longstanding advanced multiple sclerosis. |
Generate impression based on findings. | 55 years, Female, Reason: mets lung cancer. s/p one line tx,, pls c./w previous study and evaluate dz status. History: lung ca. ABDOMEN:LUNG BASES: For findings in the lung, please see dedicated chest CT performed on the same day.LIVER, BILIARY TRACT: Mild hepatomegaly.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of metastatic disease in the abdomen or pelvis. |
Generate impression based on findings. | Neuroblastoma pre-transplant evaluation.VIEW: Mandible panorex (one view) 02/24/15 Examination is limited due to motion. No large bone defect is seen. | Markedly limited exam due to motion. |
Generate impression based on findings. | 49-year-old female with history of ovarian cancer. CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: Single small spiculated nodules in the lateral left breast (series 2, image 31). Left axillary surgical clips.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. New nonspecific moderate circumferential wall thickening of the mid sigmoid colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Previously seen left anterior abdominal omental mass appears to been partially resected. Diffuse moderate abdominopelvic ascites, mildly decreased. Some of this appears loculated. Diffuse peritoneal thickening and omental infiltration.PELVIS:UTERUS, ADNEXA: Interval hysterectomy and resection of bilateral complex adnexal masses. BLADDER: No significant abnormality noted.LYMPH NODES: New mildly enlarged bilateral external iliac lymph nodes.BOWEL, MESENTERY: Normal caliber bowel without evidence of obstruction. New nonspecific moderate circumferential wall thickening of the mid sigmoid colon.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Postsurgical changes of interval hysterectomy, resection of bilateral ovarian masses, and omental debulking.2.New non-specific moderate circumferential sigmoid colon wall thickening.3.Stable small spiculated left breast nodule. |
Generate impression based on findings. | Evaluation of lung mass right side. The comparison chest radiograph performed on /24/2015 demonstrates a mass in the right mid-lung without other acute cardiopulmonary abnormality.The ventilation images show a mild decreased right lung activity on single-breath and wash-in images. There is no abnormal Xe-133 retention during the wash-out phase. The perfusion images show mild decreased right sided physiologic distribution of pulmonary perfusion.Quantitation of relative single breath ventilation (using the posterior image):Left lung: 59.73% (upper lung 11.52%; lower lung 20.10%)Right lung: 40.27% (upper lung 8.67%; lower lung 13.40%)Quantitation of relative pulmonary arterial perfusion (using anterior and posterior geometric means):Left lung: 57.75% (upper lung 13.89%; lower lung 12.24%)Right lung: 42.25% (upper lung 8.45%; lower lung 11.68%) | Mild decreased ventilation and perfusion in the right lung compared to the left lung. |
Generate impression based on findings. | Age: 79 years. Sex : Male. Reason for study: Reason: aspiration risk History: dysarthria. Fluoroscopic guidance was provided for an oropharyngeal motility study performed by the Speech Pathology section of the ENT service. The examination was recorded on videotape. No static or hard copy films were obtained. The exam was positive for penetration and negative for aspiration. FLUOROSCOPY TIME: Four minutes and 31 seconds. | The exam was positive for penetration and negative for aspiration. Please see speech pathology report for additional findings and feeding recommendations. |
Generate impression based on findings. | Female 88 years old; Reason: left frontal headache and recent nosebleed - please evaluated left frontal sinus for infection The right frontal sinus appears more opacified than the left, likely secondary to hypoplasia. The maxillary sinuses appear clear. A postoperative defect in the left temporoparietal skull is better seen on the prior head CT. | No specific features of sinusitis. However, CT may be considered if further evaluation is clinically warranted. |
Generate impression based on findings. | 42 years, Female. Reason: rule out constipation History: abdominal pain Cholecystectomy clips noted. Nonobstructive bowel gas pattern. Moderate stool burden. | Moderate stool burden. |
Generate impression based on findings. | 64 years, Male. Reason: kidney stone History: stone There is a rounded opacity projected over the expected location of the right renal pelvis. This measures 5 mm in short axis dimension and is consistent with patient's known ureteropelvic junction stone. Nonobstructive bowel gas pattern.Staple projected over the right lung base is not identified on recent CT and may be external to patient. | 5-mm opacity projected over the right ureteropelvic junction consistent with patient's known stone. |
Generate impression based on findings. | 63 year old female with history of left breast lumpectomy in November 2009 for IDC/DCIS. Patient received radiation, chemotherapy, and hormonal therapy. History of right lumpectomy for carcinoma in 1998. History of thyroid cancer diagnosed at the age of 46. 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. Stable areas of architectural distortion are again noted bilaterally in the lumpectomy beds. Surgical clips are again seen in the left breast. 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 43 years old Reason: eval OG History: eval OG Multiple support lines and tubes including an LVAD device are projected over the patient. Partially imaged tubing projected over the region of the lower esophagus is incompletely imaged. Coiling of the feeding tube within the distal esophagus is not excluded and further evaluation with chest and upper abdomen radiograph is recommended.Above average stool burden. | Partially imaged tubing projected over the region of the lower esophagus is incompletely imaged. Coiling of the feeding tube within the distal esophagus is not excluded and further evaluation with chest and upper abdomen radiograph is recommended. |
Generate impression based on findings. | Female 62 years old; Reason: left flank pain History: One week of pain The bones are demineralized, suggesting osteopenia. Moderate degenerative disk disease affects the lower thoracic spine. There is slight anterior wedging of one of the lower thoracic vertebral bodies, seen on the lateral view, with associated kyphosis, which we suspect is chronic in etiology. There is slight rightward curvature of the thoracolumbar spine.For the purposes of this examination, we are designating 6 non-rib-bearing lumbar vertebrae. There is posterior spinal fusion hardware with screws entering the L3 through L6 vertebral bodies, appearing similar to the prior study. We see no radiographic evidence of hardware complication. Disk spacer devices with bone graft material are present at the L4/L5 and L5/L6 disk spaces, appearing similar to prior. There may be fusion of the posterior aspects of the L5 and L6 vertebrae, but this is equivocal. Moderate degenerative disk disease affects the L6/S1 level. Mild degenerative disk disease affects the upper lumbar spine, with grade 1 retrolisthesis of L1 on L2. There is levoscoliosis of the lumbar spine with the apex at L1, appearing similar to the prior study. | Postoperative changes of the lumbar spine appearing similar to prior. Degenerative disk disease and kyphoscoliosis, as described above. |
Generate impression based on findings. | 56 year old with history of right breast ductal carcinoma status post lumpectomy and axillary node dissection with adjuvant chemotherapy. Status post left mastectomy in 2011 for invasive ductal carcinoma. 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 composed of scattered fibroglandular elements, unchanged in pattern and distribution. Stable postoperative distortion, density and surgical clips in the upper outer quadrant of the right breast. 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. Results and recommendations were discussed with the patient. BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | MAXILLOFACIAL: There is moderate left greater than right nasal soft tissue swelling. There is a minimally displaced left nasal bone fracture (series 8 image 123). There are blood products in the anterior nasal cavity; please correlate clinically to evaluate for possible cartilaginous nasal septal hematoma. No other acute facial fractures are identified. The nasal septum is slightly deviated to the right. The orbits and globes are intact. There is no intraorbital hematoma or stranding.HEAD: There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There is questionable soft tissue thickening along the left posterior falx, suggesting small meningioma versus dural thickening. There are scattered periventricular and subcortical white matter hypoattenuation which is nonspecific, likely representing mild age indeterminate microvascular ischemic change. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The calvarium is intact.CERVICAL: There is no acute fracture, prevertebral soft tissue swelling or atlanto-occipital dissociation. There are short pedicles in the cervical spine contributing to a congenitally slender spinal canal. There is fusion of C5 and C6 vertebral bodies, and facets. There is at least moderate spinal canal stenosis at C5-6 and C6-7, and moderate left neural foraminal stenosis at C6-7. There is narrowing of the C6-7 disk space with vacuum phenomenon. There are mild degenerative changes elsewhere in the cervical spine with small disk osteophyte complexes at C3-4, and C4-5. There is beam hardening artifact in C6 level and below limiting evaluation. | 1.Minimally displaced left nasal bone fracture with nasal soft tissue swelling.2.Moderate anterior nasal cavity blood products, correlate clinically for possible component cartilaginous nasal septal hematoma.3.No evidence of acute traumatic injury to the head or cervical spine.4.Possible small posterior falcine meningioma versus dural thickening. This can be evaluated on nonemergent MRI of the brain without and with IV contrast as clinically indicated.5.Mild to moderate cervical degenerative changes as detailed above. |
Generate impression based on findings. | Reason: Pt with a history of NSCLC s/p chemoradiation now with NED. Please compare to prior scan for surveillance. History: NSCLC surveilance CHEST:LUNGS AND PLEURA: Right paramediastinal radiation fibrosis with traction bronchiectasis unchanged. Upper lobe predominant paraseptal emphysema is stable.No new suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: Reference right hilar lymph node (image 35 series 3) is unchanged measuring 8 mm.Reference subcarinal lymph node (image 37 series 3) is unchanged measuring 7 mm.No new mediastinal or hilar lymphadenopathy.Cardiac size is normal without evidence of a pericardial effusion.Marked coronary artery calcification.CHEST WALL: Degenerative changes in the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic changes of aorta.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Degenerative changes and changes of degenerative disk disease in the lumbar spine.OTHER: No significant abnormality noted. | No interval change. No evidence of recurrent or metastatic disease. |
Generate impression based on findings. | Status post posterior spinal fusion. Fusion status? Again seen are posterior rods with screws entering the T9 through T12 vertebrae. I see no hardware complications. Moderate multilevel degenerative disk disease affects the thoracic spine also appearing similar to the prior study. | Postoperative and degenerative changes appearing similar to the prior study. |
Generate impression based on findings. | Follow-up Again seen is a small linear density dorsal to the head of the talus compatible with a small avulsion fracture. This appears similar to that seen on the prior study accounting for slight positional and technical differences. | Small density dorsal to the head of the talus likely representing a minimally displaced avulsion fracture, appearing similar to the prior study. |
Generate impression based on findings. | Right wrist pain, erythema, warmth, swelling and restricted range of motion. Status post fall. Evaluate for fracture. There is diffuse soft tissue swelling about the wrist. I see no definite acute fracture. The lunate bone appears sclerotic suggesting avascular necrosis, perhaps with slight loss of height volarly. There is also slight widening of the scapholunate interval which may reflect scapholunate ligamentous disruption and mild volar rotary subluxation of the scaphoid which I suspect is chronic in etiology. A round lucency in the distal radius likely represents a degenerative cyst. Moderate to severe osteoarthritis affects the first carpometacarpal joint. | Soft tissue swelling without definite acute fracture. Findings compatible with avascular necrosis of the lunate and arthritic changes as described above. If there is strong clinical concern for acute fracture, repeat radiographs or cross-sectional imaging may be considered. |
Generate impression based on findings. | Redemonstrated are postoperative changes related to multiple bilateral prior craniotomies. There are associated scalp defects at the left frontal craniotomy site measuring 8 mm in width and left posterior parietal craniotomy site running longitudinally along the lambdoid suture measuring 14 mm in width. The left frontal craniotomy plate is superficial but remains covered by skin.There is unchanged encephalomalacia of the right frontal lobe and left parietal lobe with associated ex vacuo dilatation of the lateral ventricles. There are scattered left sided dural calcifications. There is a small mucus retention cyst in the left maxillary sinus. The remaining imaged paranasal sinuses and mastoid air cells are normally aerated. Incidentally noted is torus mandibularis. There is degenerative spondylosis of the partially imaged cervical spine. | Postoperative changes related to multiple bilateral prior craniotomies with associated scalp defects at the left frontal and left posterior parietal craniotomy sites. No evidence of exposed hardware. |
Generate impression based on findings. | There is a stable right parietal approach ventriculostomy catheter with the tip just terminating to the left of midline adjacent to the body of the left lateral ventricle. There is interval placement of an additional left anterior parietal approach subdural drainage catheter which courses just deep to the calvarium posteriorly in the extra-axial space, with tip abutting the left lateral aspect of the temporal occipital region.There has been interval decreased extent of subdural fluid resulting in previous significant mass effect upon the left parietal lobe, although the parenchyma remains somewhat performed in this location there is also now a large amount of extra-axial air layering non-dependently in the left frontal region, with associated mild mass effect. The smaller right-sided subdural collection appears similar in size. Ventricular caliber is essentially stable on the right with interval reexpansion of the posterior body of the left lateral ventricle secondary to decreased mass effect. There is no significant residual rightward extension of left cerebral parenchyma. Third and fourth ventricles are unchanged.There is no midline shift. There is no intracranial hemorrhage. There are no areas of abnormal attenuation. Brainstem and cerebellum again appear diminutive in size. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | 1. Stable right parietal approach ventriculostomy catheter. Stable right lateral ventricle.2. New left-sided subdural drainage catheter with decreased left-sided subdural collection. Focal air in the left hemicranium secondary to the recent procedure well with mild mass effect. Decreased localized mass effect with reexpansion of left lateral ventricle.3. Stable thin right-sided subdural collection. |
Generate impression based on findings. | Pain. Fracture. Evaluation of fine detail is limited by overlying cast/splint. There is an oblique fracture of the distal fibula extending to the level of the tibiotalar joint, with approximately 5 mm of posterior displacement of the distal fracture fragment. There is widening of the medial tibiotalar gutter to approximate 6 mm suggesting deltoid ligament injury. Small densities within the medial tibiotalar gutter may represent avulsion fracture fragments or overlying artifact. There is mild deformity of the posterior aspect of the distal tibia which may represent a minimally displaced fracture, but this is equivocal. | Distal fibular fracture and other findings as described above. |
Generate impression based on findings. | Low back pain. Spondylolisthesis? There is a slight rightward curvature of the lumbar spine. There is mild multilevel degenerative disk disease with relative sparing of L2/3 and L3/4. Facet joint arthritis affects the lower lumbar spine, and there is a grade 1 anterolisthesis of L4 relative to L5. Vertebral body heights are preserved. | Degenerative arthritic changes with grade 1 anterolisthesis of L4 as described above. |
Generate impression based on findings. | Reason: r/o PE History: CP, SOB, more acute since 2/20 when he had biopsy; hx heart transplant PULMONARY ARTERIES: No evidence of a pulmonary embolus. The pulmonary artery is normal caliber.LUNGS AND PLEURA: Mild left basilar atelectasis with minimal pleural thickening.No suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Calcified mediastinal lymph nodes compatible with prior granulomatous disease.Status post heart transplant. Cardiac size is normal without evidence of the pericardial effusion.CHEST WALL: Status post median sternotomyUPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Scattered splenic and hepatic calcifications compatible with prior granulomatous disease. | No evidence of a pulmonary embolus. No acute cardiopulmonary abnormalities identified.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Female 71 years old; Reason: hx urothelial cancer, s/p surgery and chemotherapy, on surveillance History: hx urothelial cancer, s/p surgery and chemotherapy, on surveillance ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: Pancreatic duct is at the upper limits of normal. A small hypodensity in the anterior pancreas (8:115) could represent a small side branch IPMN.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: Uterus is not identified.BLADDER: Status post cystectomy with ileal conduit.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.No evidence of recurrence or metastatic disease. |
Generate impression based on findings. | Reason: hx urothelial cancer, s/p surgery and chemotherapy, on surveillance History: hx urothelial cancer, s/p surgery and chemotherapy, on surveillance LUNGS AND PLEURA: Left upper lobe calcified granuloma.Mild centrilobular emphysema with large lung volumes.No sign of pulmonary or pleural metastases.MEDIASTINUM AND HILA: No mediastinal or hilar lymphadenopathy.Mild coronary artery calcification is present, but the heart and pericardium otherwise appear normal.CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. All abdominal findings will be included in the abdomen/pelvis CT reported separately. | No evidence of thoracic metastases, or other significant chest abnormality. |
Generate impression based on findings. | Acute left hip pain. Evaluate for hip osteoarthritis. Mild osteoarthritis affects the left hip. Mild chronic-appearing enthesopathic changes are noted along the left iliac wing and ischium. I see no fracture. | Mild osteoarthritis. |
Generate impression based on findings. | Weakness D - 1, 2 Degenerative arthritic changes affecting the hand and wrist appear similar to those the seen on the prior study. I see no fracture or malalignment. Arterial calcifications are noted within the soft tissues of the wrist. | Degenerative arthritic changes appearing similar to those seen on the prior study. |
Generate impression based on findings. | 80 year-old lady with a recent fall, now with bruising and underlying pain, mostly ulnar side. Pain at site of injury, swelling, redness. Bruising on forearm and elbow. Three views of the left elbow are provided. I see no fracture, malalignment, or joint effusion. There is soft tissue swelling medially.Two views of the left forearm reveal no fracture or malalignment. There is soft tissue swelling along the ulnar aspect of the elbow and forearm. Severe osteoarthritis affects the basilar joint of the thumb. | Soft tissue swelling without fracture evident. |
Generate impression based on findings. | Slammed thumb in door. Partial avulsion of the tip.VIEWS: Left hand PA, left thumb PA/lateral (3 views) 02/24/15 The thumb fingertip has been avulsed. A bridge of tissue is present laterally and posteriorly. The tuft protrudes into the defect. No bone abnormality is seen. | Soft tissue avulsion. |
Generate impression based on findings. | Mandibular fracture status post fixation Again seen is a plate and screw device affixing the right mandibular body in near-anatomic alignment. The underlying fracture is less distinct on the current study than on the prior study, suggesting some interval healing. There is also a fracture through the posterior aspect of the left mandibular body that appears slightly less distinct on the current study than on the prior study, suggesting some interval healing. Plates, screws and wires seen affixing the mandible and maxilla on the prior study have been removed. | Healing mandibular fractures as above. |
Generate impression based on findings. | FeverVIEW: Chest AP Cardiothymic silhouette normal. Minimal patchy atelectasis in the right middle lobe. No pleural effusion or pneumothorax. G-tube, portal vein stent and multiple surgical clips in the right upper quadrant again noted. | Minimal patchy atelectasis in the right middle lobe. |
Generate impression based on findings. | Female 22 years old Reason: 22 yr old patient with ovarian cancer s/p exp lap, RSO, omentectomy, and staging 12-19-14. baseline scan prior to treatment History: none CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: No significant abnormality noted.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Borderline enlarged retroperitoneal lymph nodes. Index left third node measures 10 by 8 mm on image number 125, series number 3. This has not significant changed from previous study.Right paradiaphragmatic node now measures 11 x 9 mm on image number 69, series number 3. It was previously measuring 2.2 x 1.1 cm on image number 5, series number two.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Postsurgical changes in the midline secondary to incision.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Interval resection of large pelvic mass. Uterus is in place. There is low density fluid in bilateral adnexa which cannot be further characterized with the CT. Correlation with transvaginal ultrasound or MRI is recommended for further evaluation of the adnexa, if clinically indicated.Cystic lesion adjacent to the left psoas muscle measuring 3 x 2.3 cm on image number 166, series number 3. This may represent a lymphocele, however, a residual neoplasm cannot be excluded. Follow-up imaging is recommended.BLADDER: No significant abnormality noted.LYMPH NODES: Pelvic adenopathy. Index left external iliac node now measures 1.2 x 0.9 cm on image number 184, series number 3. This node is slightly smaller compared to previous study where it was previously measuring 1.9 x 1.1 cm on image number 184, series number 3.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | Status post resection of large pelvic mass. Small amount of low density fluid in the bilateral adnexa, nonspecific. Borderline enlarged retroperitoneal lymph nodes are stable. Slight interval decrease in the size of the right paradiaphragmatic and left pelvic lymph node.Left retroperitoneal cystic lesion which likely represents a lymphocele. Follow-up imaging is recommended to exclude residual/recurrent neoplasm. |
Generate impression based on findings. | PICC placementVIEW: Chest AP and abdomen AP Cardiothymic silhouette normal. No focal lung opacity. No pleural effusion or pneumothorax. The endotracheal tube has been removed in the interval. NG tube removed in the interval. Placement of a left lower extremity PICC with tip in the SVC. Disorganized nonobstructive bowel gas pattern. No pneumatosis or pneumoperitoneum. | Placement of left lower extremity PICC with tip in the SVC. |
Generate impression based on findings. | Leg length discrepancyVIEWS: Pelvis AP The right femoral epiphysis is slightly smaller in size in comparison to the left side. No acute fracture or dislocation. Both the acetabula are normal. | Normal acetabular development bilaterally with minimal asymmetry to the right femoral epiphysis slightly smaller than the left. |
Generate impression based on findings. | Reason: low back pain History: low back pain Five lumbar type vertebral bodies are presumed to be present. There is approximately 25% loss of vertebral body height at L5.The patient is status post L4-5 surgery with instrumentation along the spinous processes of L4 on L5. There are findings suggestive of prior laminotomy is and medial facetectomies at this level. There is some new ossification at the laminotomy sitesAt L5-S1 there is a moderate degree of bilateral facet and ligamentum flavum hypertrophy present at this level with some partial effacement of the fat of the lateral recess is left more than right as a result of facet osteophytes. There is encroachment of the exiting nerve roots within the neural foramina at this level right worse than left. Overall there is no significant change at this level when compared to the prior exam.At L4-5 there is loss of disk space height, mild anterior subluxation of L4 on L5, diffuse disk bulge and moderate to marked bilateral facet and ligamentum flavum hypertrophy with effacement of the fat of the lateral recesses. Overall there is a moderate degree of spinal stenosis present at this level. The exiting nerve roots within the neural foramina are surrounded by fat Overall there is no significant change at this level when compared to the prior exam.At L3-4 there is a disk bulge and bilateral facet hypertrophy at this level associated with some mild narrowing of the neural foramina bilaterally and mild encroachment of the exiting nerve roots. Overall there is moderate spinal stenosis at this level. There is mild posterior subluxation of L3 on L4. Overall there is no significant change at this level when compared to the prior exam.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is a disk bulge present at this level as well is some mild facet hypertrophy.At L1-2 there is no significant compromise to spinal canal or neural foramina.Atherosclerotic calcifications are present in the aorta and some of the branches. | 1.The patient is status post interspinous fusion with NuVasive clamp. There is some new ossification at the laminotomy sites of L4-5.2.There are degenerative changes present in the lumbar spine worse at L5-S1 and L4-5 where there is moderate spinal stenosis at L4-5 and encroachment of exiting nerve roots at the neural foramina at L5-S1 right worse than left. Overall there is no interval change when compared to the previous exam from 2013.3.Mild compression of L5 is stable when compared to the prior exam. |
Generate impression based on findings. | Reason: pt with a history of met renal cell cancer, please assess for disease progression History: met RCC LUNGS AND PLEURA: Benign-appearing micronodules and linear scarring, but no sign of metastases.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy.Moderate coronary artery calcifications are present, the heart and pericardium otherwise normal in appearance.CHEST WALL: Degenerative abnormalities affect the thoracic spine and there is a moderate scoliosis. UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Unchanged exophytic right hepatic lesion unchanged. This will be characterized on an MR can be performed today. Right hepatic lobe cyst.Status post right nephrectomy and adrenalectomy.Left kidney unchanged with focal calcification and a nonspecific hypodense lesion. Cholelithiasis. | No evidence of thoracic metastases. Abdominal findings to be characterized by a follow-up MRI. |
Generate impression based on findings. | Male 54 years old Reason: Peritoneal mesothelioma. Please compare to prior exam per recist criteria. History: Peritoneal mesothelioma CHEST:LUNGS AND PLEURA: Dependent atelectasis at the lung bases. Right middle lobe nodule is unchanged.MEDIASTINUM AND HILA: Borderline enlarged mediastinal lymph nodes. An index posterior mediastinal node measures 12 by 10 mm on image number 64, series number 3, not significantly changed from previous study.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: Spleen is absent.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Significant interval increase in the omental and mesenteric masses. Index omental lesion anteriorly measures 9.7 by .6 cm on image number 118, series number 3. All of the other diffuse mesenteric and omental disease also significantly increased in size.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: Please see discussion aboveBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Interval significant increase in the diffuse omental and mesenteric soft tissue masses consistent with patient no history of mesothelioma.Posterior borderline enlarged mediastinal lymph nodes are stable. |
Generate impression based on findings. | Female 37 years old Reason: Pre-Kidney Transplant, scheduled Living donor surgery 3/5/15 pt with chronic umbilical abdomen pain s/p PD cath placement 11/2014 History: CT scan with po contrast only r/o umbilical hernia The study is limited due to lack of intravenous contrast.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: Bilateral kidneys are significantly enlarged with numerous cysts of various size and density consistent with adult cholecystic kidney disease. Small amount of fluid is present around the spleen, between the upper pole of the left kidney and spleen. Solid component of these renal cysts cannot be excluded with this noncontrast study.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Peritoneal dialysis catheter is present in the left lower quadrant with small amount of ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Small amount of ascites.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Limited study due to lack of intravenous contrast. Bilateral significantly enlarged kidneys with numerous cysts of various size in density consistent with adult onset polycystic kidney disease.Small amount of ascites and peritoneal dialysis catheter. |
Generate impression based on findings. | Pierre Robin. Possible hip dysplasia.VIEW: Pelvis AP standing (one view) 02/24/15 Femoral head ossification centers are well directed into normally formed acetabula.A moderate amount of feces is present in rectosigmoid. | Normal examination. |
Generate impression based on findings. | Male 83 years old Reason: history of bladder cancer with ileal conduit, assess for recurrence History: none CHEST:LUNGS AND PLEURA: Stable micronodules.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Bilateral renal cysts and left renal stones and left renal scarring are unchanged. Right renal scarring is unchanged.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant ileostomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy.BLADDER: Status post cystoprostatectomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No significant change from previous study. |
Generate impression based on findings. | Male 35 years old; Reason: S/P resection of high grade malignant peripheral nerve sheath tumor involving the small bowel. Evaluate for recurrence of disease. History: S/P resection of high grade malignant peripheral nerve sheath tumor involving the small bowel. Evaluate for recurrence of disease. CHEST:LUNGS AND PLEURA: No significant abnormality notedMEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedOTHER: ABDOMEN:LIVER, BILIARY TRACT: Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: 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: Post surgical changes related to small bowel mass resection in the right lower quadrant. No obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No evidence of recurrence or metastatic disease. |
Generate impression based on findings. | Status post early February 2015 right thyroid lobectomy for goiter. There are post-operative changes related to a right thyroid lobectomy and isthmusectomy with soft tissue that is isoattenuating to muscle in the surgical bed. There are subcentimeter thyroid nodules in the remaining left thyroid lobe. There is effacement of the valleculae and partial effacement of the left oropharynx with prominence at the base of tongue, which is nonspecific but may be due to reactive lymphoid tissue. The airway is patent at the level of the thyroid. There is no significant residual airway deviation.There is no evidence significant cervical lymphadenopathy. The major salivary glands are unremarkable.The major cervical vessels are patent. There is degenerative spondylosis of the cervical spine with mild anterolisthesis of C4 on C5, mild retrolisthesis of C5 on C6 and C6 on C7. The osseous structures are otherwise unremarkable. There is partial opacification of the right sphenoid sinus. The imaged intracranial structures are unremarkable. The imaged portions of the lungs demonstrates a subcentimeter irregular opacity at the right lung apex which may relate to scarring. | Post-operative changes related to right thyroid lobectomy and isthmusectomy with relief of mass effect on the trachea at the level of the thyroid. Effacement of the valleculae and partial effacement of the left oropharynx along the prominent base of tongue, which is nonspecific but may relate to reactive lymphoid tissue, for which correlation with direct inspection is recommended. Residual left thyroid nodules. |
Generate impression based on findings. | Male 66 years old; Reason: history metastatic prostate cancer CHEST:LUNGS AND PLEURA: Unchanged subcentimeter right upper lobe lung nodule, image 37 series 4, nonspecific. No pleural effusion. Status post partial right lung resection. MEDIASTINUM AND HILA: Stable to mild interval decrease in size of prominent left hilar adenopathy, measuring 2.3 x 1.9 cm, previously measured 2.4 x 2 cm on earlier noncontrast imaging. Additional lymph nodes without significant change. Curvilinear hypodensity in wall of left ventricle suggestive of subendocardial infarction. Mild calcified coronary artery disease.CHEST WALL: Right chest wall port with tip near cavoatrial junction.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: Unchanged from prior study is nonspecific 8 x 7 mm hypoattenuating focus at junction of pancreatic body and tail, image 94 series 3.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Renovascular calcifications, stable renal cysts measuring simple fluid, some hypoattenuating renal lesions too small to characterize but stable from contrast enhanced 3/18/14 CT exam.RETROPERITONEUM, LYMPH NODES: Mild interval decrease in size of portacaval nodal cluster, measuring approximate likely 2.1 x 1.1 cm, image 89 series 3, previously measured 2 x 1.8 cm. Stable aortobiiliac postsurgical sequela, please note that examination not optimal for evaluation of stent graft patency but contrast opacification suggested. BOWEL, MESENTERY: Tiny hiatal hernia.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Bilateral inguinal postprocedural sequela with soft tissue induration and subcentimeter lymph nodes present. | 1. Stable to mild interval decrease in size of reference nodes as above. |
Generate impression based on findings. | Pain and swelling. Basketball injury.VIEWS: Left ankle AP/lateral/oblique (3 views) 02/24/15, 1159, 1200, 1201 Moderate soft tissue swelling is present laterally. The tibia is normal in appearance. An oblique fracture of the posterior fibular metaphysis extends into the physis. | Salter fracture distal fibula. |
Generate impression based on findings. | Back pain. Lumbar spondylolisthesis. Evaluate for preop planning of fusion. The bones appear demineralized, suggesting osteopenia. Severe degenerative disk disease affects L4/5. There is a grade 2 anterolisthesis of L4 relative to L5. Based upon the overall length of the L4 vertebra, I suspect that there is a bilateral spondylolysis at this level as well. Surgical clips and sutures are noted in the left upper quadrant. Vascular stents are noted in the pelvis. | Severe degenerative disk disease at L4/5 with a grade 2 anterolisthesis that may be due to an underlying spondylolysis. |
Generate impression based on findings. | Reason: r/o intracranial bleed History: left facial droop. on heparin gtt The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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. Atherosclerotic calcifications are present along the distal internal carotid arteries. Atherosclerotic calcifications are present along the distal vertebral arteries. | 1.No evidence for acute intracranial hemorrhage mass effect or edema.2.CT is insensitive for the early detection of acute nonhemorrhagic cerebral infarction. |
Generate impression based on findings. | Male 74 years old Reason: 74M history of bladder cancer, status post cystectomy/neobladder. Surveillance imaging History: history of bladder cancer ABDOMEN:LUNG BASES: Unremarkable.LIVER, BILIARY TRACT: Subcentimeter liver lesions are unchanged. These lesions are too small to accurately characterize. Cholelithiasis, unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Small hypodense lesions in both kidneys are grossly unchanged.RETROPERITONEUM, LYMPH NODES: Interval development of a 5.4 x 3.4 cm solid mass in the left retroperitoneum anterior to the left psoas muscle. This mass also invades the left common iliac artery and vein.A second mass is anterior to the neobladder invades the rectus muscle and measures 2.5-cm in diameter on image number 124, series number 7. There are other smaller soft tissue density masses anterior to the neobladder more inferior compared to this large mass.BOWEL, MESENTERY: Unremarkable.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: Please see discussion above on the retroperitoneum sectionBOWEL, MESENTERY: Please see discussion above on the retroperitoneum sectionBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Interval development of multiple large masses in the pelvis as described above suspicious for metastatic disease. |
Generate impression based on findings. | Fell. Fracture? Evaluation of the lower cervical spine and cervicothoracic junction on the lateral views is limited by overlying anatomy. The bones appear demineralized. I see no fracture or prevertebral soft tissue swelling. There is severe multilevel degenerative disk disease. There is moderate multilevel facet joint osteoarthritis and multilevel neuroforaminal narrowing bilaterally. There is a grade 1 anterolisthesis of C4 relative to C5. Calcifications in the soft tissues lateral to the cervical spine likely reside in the carotid vasculature. | Degenerative arthritic changes as described above without fracture evident. If there is strong clinical concern for cervical spine fracture, then CT is recommended. |
Generate impression based on findings. | Male 72 years old Reason: urothelial cancer, on surveillance History: urothelial cancer, on surveillance CHEST:LUNGS AND PLEURA: Calcified micronodules are unchanged.MEDIASTINUM AND HILA: Small mediastinal lymph nodes are unchanged.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: There is a heterogeneously enhancing lesion in the upper pole of the left kidney measuring 1.4 x 1.7 cm on image number 93, series number 8. This lesion is suspicious for renal cell carcinoma. Further evaluation with dedicated renal mass protocol CT or MRI is recommended.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Right lower quadrant ostomy.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Status post cystoprostatectomy. BLADDER: Status post cystoprostatectomy.LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Right inguinal hernia containing nonobstructed bowel segments.OTHER: No significant abnormality noted | Right upper pole renal lesion suspicious for a small renal cell carcinoma. Further evaluation with renal mass protocol CT or MR is recommended. |
Generate impression based on findings. | 13-week-old former 27 week gestational age patient with pleural effusion.VIEW: Chest AP (one view) 02/24/15, 1108 A moderate size left pneumothorax has developed in the interval. Mediastinum is shifted. No pleural fluid is identified. Left lung is compressed. Hazy opacity on the right is most likely in part due to atelectasis/compression. Cardiac silhouette size is normal.Endotracheal tube tip is between thoracic inlet and carina. Feeding tube tip is distal to proximal body of stomach and not included on the image. Left chest tube remains in place. Right central line tip is in right atrium. | Development of moderate left pneumothorax. |
Generate impression based on findings. | Pain on palpation of lumbar spine. Rule out lumbar vertebrae fracture status post MVA. I see no fracture or malalignment. Mild degenerative disk disease affects L2/3, L3/4, and perhaps L5/S1. There are posterior vertebral body osteophytes at L3/4. Vertebral body heights are preserved. There is mild facet joint osteoarthritis of the lower lumbar spine. | Mild degenerative arthritic changes as described above; no fracture is evident. |
Generate impression based on findings. | Female 34 years old , hematuria and flank pain ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is an appendicolith in the appendix.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | No evidence of renal stones. |
Generate impression based on findings. | Knee pain Four views of the right knee are provided. Severe osteoarthritis affects the knee, particularly the lateral and patellofemoral compartments. There is a moderate sized joint effusion. There is a geographic lucent lesion within the fibular head measuring approximately 4 cm in craniocaudal dimension and resulting in mild expansile remodeling of the bone.Relatively mild osteoarthritis affects the left knee as seen on the frontal views. | 1.Severe osteoarthritis.2.Right fibular head lesion lucent lesion is nonspecific. It may simply represent an intraosseous ganglion, but other entities such as giant cell tumor of bone cannot be excluded. A malignant lesion is considered less likely. It can be further evaluated with MRI. |
Generate impression based on findings. | Reason: Tonsillar cancer; compare to previous with measurements. CT neck:The patient is status post right neck surgery with a right radical neck dissection and a myocutaneous flap placement. There is adjacent infiltration of the soft tissues surrounding the right carotid space which is likely treatment related. There is atrophy of the right tongue redemonstrated. The submandibular glands have been removed.Within the suprahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated. Within the infrahyoid neck on the basis of size criteria for lymphadenopathy no lymphadenopathy is appreciated.Within the visceral space the thyroid gland appears intact.The airway appears patent.The parotid glands appear intact.The visualized lung apices are airspace opacities in the right upper lung fieldThe carotid and vertebral vasculature visualized on this exam appears intact.The cervical vertebral bodies in general are intact with no evidence for canal stenosis.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No acute intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.Atherosclerotic calcifications are present along the distal internal carotid arteries. | 1.No evidence for local recurrence or neck lymphadenopathy on the basis of CT size criteria for lymphadenopathy2.No evidence for brain metastases.3.Air space opacities are present in the right upper lung field. Please refer to CT of the chest of the same date for further comments. |
Generate impression based on findings. | Staging malignant pleural mesothelioma status post right pleural biopsy.IMAGES: Submitted for interpretation are soft copy FDG PET/CT images from the skull base through the thighs dated 2/3/15 from HighTech. (The nonenhanced CT images were obtained solely for purposes of completing the PET scan, are not of diagnostic quality and are thus not interpreted or used to diagnose disease independently of the PET images.) Today's CT portion grossly demonstrates a medium-sized somewhat lobular right pleural effusion. Extensive atherosclerotic calcifications are seen in the left anterior descending coronary artery.Today's PET examination demonstrates several crescentic foci of significantly increased activity involving the right pleura most notably in its mid and lower portions (SUV max = 8.3), compatible with the patient's diagnosis of mesothelioma. Abnormal crescentic activity extends along the right lateral hepatic capsule with an inferior focus to the mid level of the right kidney. However, these are all considered most likely to represent extension of pleural-based tumor rather than intra-abdominal tumor.Increased activity tracts to the chest wall in the right lateral mid thorax with extension to the subcutaneous tissues. This is consistent with postbiopsy inflammation although right chest wall tumor extension/seeding cannot be entirely excluded.No abnormal activity is seen within the mediastinum, left chest, or within the upper abdomen proper. A punctate benign arthritic focus is seen at the sternomanubrial junction.A small focus of markedly increased activity (SUV max = 9.8) is seen along the inferior right lateral aspect of the prostate gland. It is uncertain if this resides within the prostate parenchyma or represents excreted physiologic urine such as a small diverticulum. If the former, then this could represent a neoplastic or inflammatory prostate focus. | 1.Several abnormal hypermetabolic right pleural-based foci, consistent with mesothelioma.2.No convincing contralateral or extrathoracic mesothelioma tumor activity.3.Possible right prostate focus raises the question of prostate cancer although FDG is insensitive and nonspecific for this. Clinical correlation and with possible prostate ultrasound may be useful, however.4.Extensive atherosclerosis of the left anterior descending coronary artery. Correlate clinically as to the need for further evaluation such as with cardiac perfusion scintigraphy. |
Generate impression based on findings. | Right ankle fracture status post reduction Evaluation of fine detail is limited by overlying cast material. Again seen is an oblique fracture of the distal fibula with approximately 5 mm of posterior displacement of the distal fracture fragment. Also again seen is widening of the medial tibiotalar gutter to approximately 5 mm. A mildly displaced fracture of the "posterior malleolus" is better visualized on this study than on the prior study. | Distal fibular and posterior malleolar fractures with widening of the medial tibiotalar gutter indicating deltoid ligament injury. |
Generate impression based on findings. | Lower back pain for several years. For the purposes of this study I will designate 5 lumbar vertebrae with hypoplastic ribs at L1. Vertebral body heights and intervertebral disk spaces appear normal for age. Mild facet joint osteoarthritis affects L5/S1. Alignment is within normal limits. | Mild facet joint osteoarthritis as above. |
Generate impression based on findings. | Status post left total knee arthroplasty Components of a left total knee arthroplasty device are situated near anatomic alignment without radiographic evidence of hardware complication. Skin staples, a drain, and foci of gas density within the soft tissues reflect recent surgery. | Postoperative changes of total knee arthroplasty as above. |
Generate impression based on findings. | The right uterine artery was embolized using multiple 4 mm coils. Post-embolization angiogram demonstrated no flow beyond the coils.The Ann Roberts catheter was used to select the left internal iliac artery and multiple left internal iliac angiograms were performed to attempt to select the left uterine artery to reassess AVM supply. Unable to select this vessel due to spasm. No supply was seen on initial angiogram, therefore no further intervention was performed. Right common femoral angiogram was performed through the sheath demonstrating patent right common femoral artery. Angio-seal closure device was used to achieve hemostasis.The patient tolerated the procedure well without immediate complication. Routine post procedure instructions were documented in the chart and relayed to the referring clinical team.FLUOROSCOPY TIME: 23.1 MinutesAIR KERMA: 344.85 mGyESTIMATED BLOOD LOSS: Less than 5cc. | Successful coil embolization of right uterine artery branch supplying uterine AVM.PLAN: The patient will be admitted overnight for pain control and observation. |
Generate impression based on findings. | History of sarcoma of left upper extremity status post excisional lymph node biopsy with positive lymph node. Please evaluate for metastatic disease. RADIOPHARMACEUTICAL: 14.4 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 93 mg/dL. Today's CT portion grossly demonstrates post-surgical changes in the left axilla with surgical clips, small left axillary lymph nodes, and linear soft tissue density. Today's PET examination demonstrates multiple foci of activity within the medial aspect of the proximal left forearm extending up the left upper arm (max SUV = 5.4 in the region of the left elbow). Mildly hypermetabolic activity is also noted in small left axillary lymph nodes (max SUV = 2.95). No suspicious FDG avid lesion is identified in the head/neck, abdomen, pelvis, or lower extremities. Minimal activity within the endometrium is likely physiologic in a premenopausal female. | 1. Hypermetabolic activity within the left axilla and multiple foci within the left upper arm and proximal forearm are consistent with recurrent sarcoma. 2. No suspicious FDG avid lesion is identified in the head/neck, abdomen, pelvis, or lower extremities. |
Generate impression based on findings. | There are multiple areas of wedge shaped abnormal low density throughout the cerebral hemispheres bilaterally with loss of gray-white differentiation. The most confluent area is in the left frontal lobe with an additional prominent area in the left posterior parietal lobe. There is no significant associated volume loss in these locations. There are multiple other ill-defined areas of abnormal low density with suggestion of sulcal effacement and blurring of the gray-white junction.The ventricles and sulci are otherwise prominent, consistent with mild age-related volume loss. There is no midline shift or mass effect. There is no intracranial hemorrhage. There is no extraaxial fluid collection. The visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. | No acute intracranial hemorrhage. Numerous areas of wedge-shaped and ill-defined abnormal low density throughout the cerebral hemispheres bilaterally with associated loss of gray-white differentiation and sulcal effacement. Findings are concerning for multifocal possibly embolic recent infarcts, and MRI of the brain is recommended. |
Generate impression based on findings. | Status post fall. Evaluate for bleed. Redemonstrated is a thin hyperattenuating band along the right falx, measuring approximately 3 mm in width. There is a left posterior temporal occipital subgaleal hematoma, unchanged. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. There are atherosclerotic calcifications of the cavernous portions of the bilateral internal carotid arteries. There are postoperative changes of the bilateral anterior maxillary sinuses with chronic appearing moderate right maxillary mucosal thickening. There are scattered opacification of the right anterior ethmoid air cells. The remaining imaged paranasal sinuses and mastoid air cells are clear. The skull is unremarkable. There is a left lens implant. | 1. Stable appearance of 3 mm right-sided falcine subdural hematoma.2. Left posterior temporal occipital scalp/subgaleal small hematoma. |
Generate impression based on findings. | 4-year-old male with history of neuroblastoma, status post induction chemo therapy, history of ascites, rule out VOD LIVER: The liver measures 13 cm. No focal hepatic lesions. GALLBLADDER, BILIARY TRACT: No biliary ductal dilatation. The gallbladder appears normal without wall thickening or pericholecystic fluid.PANCREAS: The pancreas is obscured by bowel gas.SPLEEN: The spleen measures 7.2 cm.KIDNEYS: The right kidney measures 7.8 cm. Left kidney measures 7.0 cm. No focal lesion or hydronephrosis.OTHER: Moderate ascites with debris. The bowel wall is mildly thickened.DOPPLER: Color and spectral Doppler were performed on inflow and outflow vessels | Moderate abdominal ascites. Patent vasculature without evidence of VOD. |
Generate impression based on findings. | Lower abdominal pain. Nausea and vomiting. Repeat evaluation for appendicitis.EXAMINATION: Sonogram abdomen/appendix 02/24/15 The appendix is no longer visible. The patient indicates that she can no longer point with one finger to the exact location of pain. A few lymph nodes are noted in right lower quadrant. | Appendix no longer visualized. |
Generate impression based on findings. | Male 56 years old Reason: metastatic renal cancer on long term everolimus, assess for progression History: none Limited exam secondary to lack of intravenous contrast. Evaluation of solid organs and vascular pathology is suboptimal.CHEST:LUNGS AND PLEURA: Innumerable bilateral pulmonary metastatic lesions, which are grossly stable in size.Reference right middle lobe nodule measures 0.9 x 0.6 cm (series 4, image 59), with previously 0.9 x 0.6 cm.Reference left lower lobe pulmonary nodule measures 1.0 x 0.8 cm (series 4, image 81), previously 1.2 x 1.0 cm. Centrilobular emphysema again seen.MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Mild coronary artery calcifications.Reference subcarinal lymph node measures 1.8 x 0.8 cm (series 3, image 44), previously 1.8 x 0.8 cm.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Right hepatic lobe lesion is stable in size measuring 1.8 x 1.4 cm (series 3, image 107), previously 1.7 x 1.4 cm.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Postoperative changes from right nephrectomy. Soft tissue mass in the right nephrectomy bed measures 4.4 x 2.3 cm (series 3, image 108), previously 4.5 x 2.2 cm.Satellite lesion between the liver and the right nephrectomy bed measures 1.7 x 1.8 cm (series 3, image 107), previously 1.7 x 1.6 cm.RETROPERITONEUM, LYMPH NODES: Mild atherosclerotic calcifications of the abdominal aorta and its branches. Patulous air-filled esophagus.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: Lytic lesions in the L3 vertebral body, stable.OTHER: No significant abnormality noted | Limited exam secondary to lack of intravenous contrast making evaluation of solid organs suboptimal. Within these limitations, patient is status post right nephrectomy with stable size of the metastatic lung nodules and surgical bed lesions when compared to prior exam. Lesions may be slightly increased in size since exam from 2013. |
Generate impression based on findings. | Female 60 years old Reason: pain and swelling History: pain. Two views of the right hip show mild osteoarthritis.AP view of the pelvis shows mild osteoarthritis of both hips. Degenerative arthritic changes affect the lower lumbar spine. | Mild osteoarthritis. |
Generate impression based on findings. | Female 69 years old Reason: bunion History: pain. We have 4 views of the left foot. The bones appear demineralized. There are chronic arthritic changes of the first metatarsophalangeal joint likely representing a combination of long-standing rheumatoid arthritis and osteoarthritis with a bony excrescence projecting from the medial aspect of the first metatarsal head. There is slight lateral subluxation of the proximal phalanx of the first toe with hallux valgus deformity. There are hammertoe deformities of the second through fifth toes with dorsal dislocation of the third proximal phalanx relative to the third metatarsal head. Overall these findings are similar to those seen on the prior study.We have 4 views of the right foot. The bones are demineralized. Again seen is a lateral subluxation of the proximal phalanx relative to the first metatarsal head associated with a severe hallux valgus deformity. There is dorsal subluxation/dislocation at the second, third, and fourth metatarsophalangeal joints with associated hammertoe deformities. There is chronic erosive deformity of the proximal interphalangeal joint of the fifth toe which appears similar to that seen on the prior study. Overall, the findings are similar to those seen on prior studies. | Arthritic changes as described above appearing similar to those seen on prior studies. |
Generate impression based on findings. | Patient with Intractable pruritus and facial nodules. Previously diagnosed with IgG4 related disease. Please evaluate for involvement of salivary glands, pancreas, hepatobiliary system and retroperitoneal area.RADIOPHARMACEUTICAL: 12.3 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 134 mg/dL. Today's CT portion grossly demonstrates skin thickening of the left frontal scalp region. Incidental note is made of a prominent left intra-parietal sulcus compared to the right. Prominence of the parotid glands bilaterally with nodular soft tissue density lesions likely representing intraparotid lymph nodes. Mildly enlarged mediastinal and hilar lymph nodes. Cholelithiasis. Atherosclerotic calcifications of the abdominal aorta and its proximal branches, including the coronary arteries. Incidental detection of a right L5-S1 pars defect. A groundglass nodular opacity is noted in the right upper lobe of the lung. Additional perifissural groundglass opacities are noted bilaterally.Today's PET examination demonstrates significantly increased FDG avid activity within the parotid gland lymph nodes bilaterally. The SUVmax of a left intra-parotid gland lymph node is 6.9. Increased activity is also noted within mediastinal and hilar lymph nodes. Linear area of decreased activity in the left parietal region of the brain corresponds with the prominent left intra-parietal sulcus. Nonspecific increased activity is seen in the left frontal scalp region which corresponds with the region of skin thickening on CT. Increased colonic activity likely is related to metformin use. Correlate clinically. No abnormal activity was detected in the thyroid gland, pancreas, retroperitoneal region or hepatobiliary region. | Increased FDG avid activity in the lymph nodes within the parotid glands bilaterally and in the mediastinum and hilar regions. The differential diagnosis includes IgG4-RSD, sarcoidosis, lymphoma and less likely metastatic tumor. |
Generate impression based on findings. | Postoperative changes from previous T2-L1 posterior spinal fusion are again noted, with mild residual rotatory scoliosis. Susceptibility artifact is noted from the spinal instrumentation which limits evaluation of surrounding structures.There is redemonstration of a slightly heterogeneous dorsal epidural collection extends from the mid C3 level to the mid T1 level. There are persistent foci of susceptibility within this collection on the gradient echo images. The collection is more homogeneously T1 hyperintense likely relating to expected evolution of blood products, and remains overall T2 hyperintense with perhaps slight decreased heterogeneity on the sagittal sternum images. The collection continues to measure up to 4 mm in greatest thickness resulting in partial effacement of CSF space along the cervical cord.There has been significant improvement in appearance of the cord signal and decreased cord expansion, with minimal patchy areas of persistent T2/STIR hyperintensity within the cord at the upper C5 and C6 levels. Cord flattening is suggested at the upper C6 level which may indicate evolving myelomalacia. There is stable mild reversal of the normal cervical lordosis and mild posterior disc osteophyte complexes at C4-C5 and C5-C6 which again contribute to spinal canal narrowing, which is at least moderate at these levels.There are also scattered thoracic epidural blood products again suggested although incompletely evaluated due to the artifact, without spinal cord compression. The spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1-L2 level.There scattered trace fluid within the mastoid air cells bilaterally. There are prominent areas of pulmonary opacity, new in the right upper lobe with air bronchograms, and within the left greater than right lower lobes. Previous right-sided pleural effusion is much decreased in size. | 1. Interval expected evolution of dorsal epidural hematoma from C3 to T1, with overall stable size and persistent superimposed mid cervical spondylotic changes and reversed cervical lordosis contributing to overall at least moderate central spinal stenosis with near complete effacement of CSF space.2. Cervical cord signal is much improved with resolved cord edema, with residual abnormalities at the C5 and C6 levels and suggestion of development of myelomalacia at the upper C6.3. Similar appearance of scattered thoracic epidural blood products, with incomplete evaluation secondary to extensive artifact from instrumentation.4. New area of pulmonary opacity at the right lung apex with additional left greater than right lower lobe pulmonary opacities. These may represent areas of atelectasis and/or consolidation, and clinical correlation is recommended. |
Generate impression based on findings. | 85-year-old male with history of bladder cancer status post cystectomy and ileal conduit urinary diversion in February 2014. CHEST:LUNGS AND PLEURA: Mild apical predominant emphysema. There is a solid pulmonary nodule in the right lower lobe (series 6, image 75) measuring 1.2 x 1.0 cm, unchanged since 4/1/2014. Additional scattered non-specific calcified and noncalcified pulmonary modules are also present, not significantly changed. No consolidation or pleural effusions. Bilateral pleural calcifications are again noted. MEDIASTINUM AND HILA: Small subcentimeter mediastinal lymph nodes are unchanged from the prior exam. Moderate coronary artery calcifications are present.CHEST WALL: No significant abnormality notedABDOMEN:LUNG BASES: LIVER, BILIARY TRACT: Nonspecific hypoattenuating lesions in the liver noted, too small to reliably characterize but unchanged.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Nodular thickening of the right adrenal gland with areas measuring less than 0 HU compatible with benign adenoma, unchanged. KIDNEYS, URETERS: The previously described enhancing left upper pole renal mass has been resected. There is mild fat induration at the resection site, likely postsurgical. Right and left renal simple cysts appear similar to prior.Status post ileal conduit urinary diversion. A right nephroureteral stent is new from prior. No hydronephrosis. Kidneys excrete contrast symmetrically.RETROPERITONEUM, LYMPH NODES: Interval placement of infrarenal IVC filter. Moderate atherosclerotic disease of the abdominal aorta and its branches with tortuosity of the iliac vessels.BOWEL, MESENTERY: Postsurgical changes of ileal conduit. Normal caliber bowel without evidence of obstruction.BONES, SOFT TISSUES: Moderate degenerative changes affect the visualized thoracolumbar spine. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: Status post cystectomy. LYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical changes of ileal conduit. Normal caliber bowel without evidence of obstruction.BONES, SOFT TISSUES: Lytic lesion involving the left acetabulum, unchanged. Moderate degenerative changes affect the visualized thoracolumbar spine. OTHER: No significant abnormality noted | 1.Interval resection of left upper pole renal mass without evidence of local recurrence.2.Postsurgical changes of cystectomy and ileal conduit. 3.Nonspecific 1.2-cm right lower lobe pulmonary nodule stable since 4/1/2014. If prior outside examinations are available, these may be helpful to evaluate for stability. In the appropriate clinical setting, could also be further evaluated with PET. 4.Lytic lesion involving the left acetabulum, unchanged. |
Generate impression based on findings. | Malignant pleural mesothelioma. The comparison chest radiograph performed on 2/24/2015 demonstrates a moderate right pleural effusion and overlying compressive atelectasis. The ventilation images show delayed activity in the right lower lung single-breath and wash-in images. There is no abnormal Xe-133 retention in the lungs during the wash-out phase. Abnormal retention of Xe-133 in the liver suggests hepatic steatosis. The perfusion images show matched perfusion defects in the right lower lung. Quantitation of relative single breath ventilation (using the posterior image):Left lung: 53% (upper lung 11%; middle lung 24%; lower lung 18%)Right lung: 47% (upper lung 12%; middle lung 25%; lower lung 10%)Quantitation of relative pulmonary arterial perfusion (using anterior and posterior geometric means):Left lung: 53% (upper lung 14%; middle lung 11%; lower lung 28%)Right lung: 47% (upper lung 12%; middle lung 25%; lower lung 10%) | 1. Fairly symmetric ventilation and perfusion images as quantified above.2. Probable hepatic steatosis. |
Generate impression based on findings. | Reason: s/p sarcoma resection 10/2013 History: s/p sarcoma resection LUNGS AND PLEURA: No evidence of pulmonary or pleural metastases.MEDIASTINUM AND HILA: There is no mediastinal or hilar lymphadenopathy.Mild aortic root calcification is present, but no visible coronary calcifications, the heart and pericardium otherwise unremarkable.CHEST WALL: Mild degenerative abnormalities affect the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Incompletely imaged. | No evidence of metastases, or other significant abnormality. |
Generate impression based on findings. | Male 67 years old Reason: eval OA deformity History: L foot pain. We have 3 views of the right foot. There is a moderate to severe pes planus deformity. The midfoot lies in abduction and there is relative adduction of the forefoot. There is a silastic implant replacing the first metatarsophalangeal joint. There are deformities of the proximal interphalangeal joints of the second, third, and fourth toes and fifth metatarsal head, likely reflecting prior surgery.We have 3 views of the right ankle. Other than plantar flexion of the talus, the tibiotalar joint is unremarkable. Arterial calcifications are seen in the soft tissues.We have 3 views of the left foot. There is a moderate to severe flatfoot deformity with slight abduction of the midfoot and adduction of the forefoot. There is a silastic implant replacing the first metatarsophalangeal joint. There there are deformities of the fifth metatarsal head as well as the proximal interphalangeal joints of the second and fifth toes, likely reflecting prior surgery.We have 3 views of the left ankle. There are tiny tibiotalar joint osteophytes and arterial calcifications in the soft tissues of the ankle. | Foot deformities and postoperative changes as described above. |
Generate impression based on findings. | Stage IV Hodgkin's lymphoma status post completion of 6 cycles of ABVD in 2010 now with increased lymph nodes noted via OSH CT scan and elevated LDH.RADIOPHARMACEUTICAL: 14.4 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 117 mg/dL. Today's CT portion grossly demonstrates diffuse lymphadenopathy including the left level II/III cervical, left superior mediastinal, right paratracheal, subcarinal, right hilar, bilateral axillary, retroperitoneal, pelvic (including bilateral common iliac and external iliac) and inguinal regions. The anterior ventral hernia/eventration is again noted. Mucosal thickening and mucous retention cyst in the maxillary sinuses. A nodular density is noted in the right upper lobe of the lung. Subpleural lymph nodes/pleural thickening are also noted bilaterally in the lower medial lung bases.Today's PET examination demonstrates abnormally increased FDG avid activity within the left superior mediastinal, right paratracheal, subcarinal, right hilar, bilateral axillary, retroperitoneal, juxta hepatic, retrocrural, peripancreatic, pelvic, common iliac, external iliac, obturator and inguinal lymph nodes. Significantly increased FDG avid activity is also noted within the subpleural lymph nodes/pleural thickening bilaterally in the medial posterior lung bases. For reference, an SUVmax of 20 is noted in the left medial lung base. For reference the most active region of lymphadenopathy is seen within the right common iliac region where a lymph node has a SUVmax of 32.5. | Recurrence of significantly increased FDG avid tumor in the neck, chest, abdomen, pelvis and inguinal regions. |
Generate impression based on findings. | 26 year old male with ALL, prior fungal pneumonia. Assess for interval change. LUNGS AND PLEURA: There has been mild interval increase in right lung base consolidation as well as development of new dependent atelectasis in the bilateral costophrenic angles. The previously described mycetoma is not definitively visualized on the current exam. Trace right pleural effusion. Diffuse bronchial wall thickening again noted. MEDIASTINUM AND HILA: Normal heart size with small pericardial effusion. Scattered small mediastinal lymph nodes are again noted, likely reactive. Left subclavian central venous catheter tip in left brachiocephalic vein. No coronary calcifications. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Splenomegaly, similar to prior study. | Mild interval increase in right lower lobe consolidation with new dependent atelectasis in the costophrenic angles. Findings are compatible with the clinical diagnosis of fungal pneumonia. |
Generate impression based on findings. | There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage. There are no extraaxial fluid collections or subdural hematomas. The ventricles and sulci are normal in size. The visualized portions of the paranasal sinuses and mastoid air cells are clear. There is nonspecific slight symmetric prominence of the extra-axial space under the tentorium. | Negative unenhanced brain CT. |
Generate impression based on findings. | 86 year old with history of right lumpectomy in 2002 for DCIS. Patient received radiation and hormonal therapy. No new breast complaints. Three standard views of both breasts with two spot compression 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. Stable postsurgical volume loss and architectural distortion are present in the lumpectomy bed. Stable focal asymmetries and masses are present in the left breast. 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. |
Generate impression based on findings. | Cirrhosis, TIPS, evaluate for lesion and TIPS patency LIMITED ABDOMENLIVER: Cirrhotic morphology, liver measures 16.5 cm. No discrete liver lesion. Mild intrahepatic biliary duct dilatation.BILIARY TRACT: Status post cholecystectomy.PANCREAS: Not well seen due to overlying bowel gas.SPLEEN: Measures 11 cm. RIGHT KIDNEY: Right kidney measures 11.5 cm, left kidney measures 10.7 cm. No hydronephrosis. | 1. Patent TIPS, velocity mildly decreased compared to prior exam. 2. Cirrhotic liver, no focal lesion delineated. Mild intrahepatic biliary duct dilatation. |
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