instruction stringclasses 1 value | input stringlengths 6 8.98k | output stringlengths 5 3.11k |
|---|---|---|
Generate impression based on findings. | 10-day-old male with bilateral hydronephrosis, bilateral hydroureters and bilateral hydroceles on prenatal ultrasound.VIEW: Abdomen AP (one view) 2/17/2015 10:30 Nonobstructive bowel gas pattern. No free air or portal venous gas. | Normal examination. |
Generate impression based on findings. | History of FIGO IB2 poorly differentiated cervical squamous cell carcinoma status post definitive chemotherapy and radiation, completed 11/24/2014. Please evaluate disease status as above.RADIOPHARMACEUTICAL: 12.1 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 87 mg/dL. Today's CT portion grossly demonstrates mucosal thickening of bilateral ethmoid and maxillary sinuses. There has been interval decrease in size of multiple pelvic lymph nodes and the cervical mass. There is diffuse hepatic parenchymal hypoattenuation compatible with hepatic steatosis.Today's PET examination demonstrates resolution of previously described activity within pelvic lymph nodes and a cervical mass. No significant FDG avid lesion is identified in the neck, chest, abdomen, or pelvis. Minimal FDG uptake in normal morphologic inguinal lymph nodes is likely reactive change. Minimal activity within the distribution of the vagina is decreased from the prior examination and likely represents post-therapeutic change. | 1.No evidence of FDG avid tumor. 2.Hepatic steatosis. |
Generate impression based on findings. | 17-year-old male with colicky abdominal pain. Evaluate for obstructionVIEWS: Abdomen AP erect and supine (two views) 2/24/2015 Average stool burden with a nonobstructive bowel gas pattern. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | No evidence of recurrent tongue mass or significant cervical lymphadenopathy. There is an unchanged partly calcified left level 2 lymph node measuring 7 x 5 mm. There is mild atrophy of the left submandibular gland and parotid gland without change. The thyroid and major salivary glands are otherwise unremarkable. The major cervical vessels are patent. The osseous structures show no focal lesions. The airways are patent. The imaged intracranial structures are unremarkable. Please refer to dedicated accompanying CT chest report for further details. | No locally recurrent disease or pathologic cervical lymphadenopathy.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Reason: anterior mediastinal mass History: dysphagia LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Thyroid tissue extends inferiorly as far as the head of the left clavicle, but not into a retrosternal region.There is no anterior mediastinal mass.No lymphadenopathy identified.Severe coronary artery calcifications are present, and the main pulmonary artery is slightly large at 31 mm.CHEST WALL: Only mild degenerative changes affect the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Upper abdominal surgical clips or metal fragments. | Prominent thyroid, which does not extend retrosternally. No evidence of a mediastinal mass or other significant abnormality. |
Generate impression based on findings. | 16 year-old male with pain and swelling.VIEWS: Right knee AP, oblique and lateral (3 views) 2/24/2015 Joint effusion about the knee with no evidence of fracture or dislocation. Alignment is normal. | Joint effusion with no evidence of fracture. |
Generate impression based on findings. | Ms. Klipstein is a 68 year old female with a personal history of simple right mastectomy in January 2007 for invasive mammary carcinoma with mixed lobular and ductal features followed by delayed reconstruction and Arimidex therapy. She has no current breast related complaints. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Scattered benign calcifications are present. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the left breast. Benign lymph nodes project over the left axilla. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Male 42 years old Reason: knee pain History: pain. We have 4 views of the right knee which show no fracture, malalignment, joint effusion, or frank arthritic changes. A cluster of tiny densities projecting anterior to the proximal fibula may represent dystrophic soft tissue calcifications or perhaps phleboliths, but are of questionable clinical significance.We have 4 views of the left knee which likewise appear normal. There are no radiographic findings to account for patient's pain. | Essentially normal-appearing knees with no specific radiographic findings to account for the patient's pain. A small cluster of calcifications anterior to the proximal right fibula may be dystrophic in etiology or, perhaps, represent a small venous malformation but are not necessarily of any clinical significance. |
Generate impression based on findings. | 61 year old male with history of HCV and EtOH cirrhosis s/p OLT and subtotal colectomy with end ileostomy (once revised 2/2 ischemia) here for worsening N/V not related to food intake. Patient reports he has been feeling dizzy and losing consciousness frequently when changing position (orthostatic hypotension?) The scout film shows a nonobstructive bowel gas pattern and multiple surgical clips in the right upper quadrant and suture material in the pelvis. Single contrast visualization of the esophagus showed no morphologic abnormalities of the mucosal surfaces or mural contours. The stomach was normal in size, shape, and position. Spontaneous emptying of contrast into the duodenal sweep was observed. The duodenal bulb and sweep were within normal limits. Fluoroscopic evaluation showed normal mucosa throughout the small bowel, with no ulcers, sinus tracts, or fistulae. Multiple fixed loops of angulated bowel were noted adjacent to the ostomy site (arrows in series 20-24) consistent with adhesions without evidence of obstruction. The patient pointed to the source of most pain (series 14), correlating with site of adhesions. No separation of bowel loops was present to suggest fibrofatty proliferation. The remainder of the bowel loops were freely mobile during fluoroscopically monitored palpation. Transit time to the ileostomy was 75 minutes. No internal hernias or ventral hernias were evident.TOTAL FLUOROSCOPY TIME: 10:54 minutes | Multiple nonobstructive adhesions adjacent to the ileostomy correlating with pain on palpation. |
Generate impression based on findings. | Male 24 years old; Reason: evaluate for torsion History: pain, swelling RIGHT TESTIS: Measures 4.0 x 2.1 x 2.9 cm. Normal echotexture, no focal mass identified.LEFT TESTIS: Measures 4.0 x 2.8 x 3.2 cm. Normal echotexture, no focal mass identified.RIGHT EPIDIDYMIS: Measures 1.2 x 0.9 x 1.9 cm.LEFT EPIDIDYMIS: Measures 1.3 x 1.1 x 0.9 cm and contains a 0.4 x 0.5 x 0.6 cm simple cyst. | 1.Increased vascularity in the left epididymis, appearance compatible with acute epididymitis.2.No evidence of testicular torsion. |
Generate impression based on findings. | Male 67 years old Reason: r/o DJD History: neck, shoulder, and left hip pain. We have two views of the left hip. Moderate osteoarthritis affects the hip with an approximately 1 cm lucency in the acetabular dome that likely represents a degenerative cyst. Small focus of heterotopic ossification in the posteromedial thigh likely reflects old trauma. We have six views of the cervical spine. The lower cervical spine and cervicothoracic junction are not well seen on the lateral view due to overlying anatomy. There is moderate to severe degenerative disk disease at C5/C6 and mild to moderate degenerative disk disease at C6/C7. There is moderate multilevel facet joint osteoarthritis and neuroforaminal narrowing bilaterally. There is grade 1 anterolisthesis of C4. | Degenerative arthritic changes of the left hip and cervical spine as described above. |
Generate impression based on findings. | Reason: Evaluate lung parenchyma History: RV dysfunction LUNGS AND PLEURA: Bilateral air space and interstitial opacities with a somewhat patchy distribution and moderate bilateral symmetrical pleural effusions, new since the previous scan from 11 days ago.MEDIASTINUM AND HILA: No pericardial effusion..Moderate coronary artery calcification. Mitral annulus calcification.Moderately enlarged noncalcified mediastinal lymph nodes, likely reactive. Calcified mediastinal lymph nodes consistent with healed granulomatous disease.CHEST WALL: Status post median sternotomy. Mild degenerative disease in the spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Large amount of ascites with cirrhotic liver morphology. Status post cholecystectomy. | 1. Interval development of airspace and interstitial pulmonary opacity, nonspecific but compatible with edema.2.Moderate bilateral pleural effusions. |
Generate impression based on findings. | 55-year-old female with history of metastatic colon cancer. CHEST:LUNGS AND PLEURA: Solid pulmonary nodule in the left upper lobe (series 4, image 32) measures 0.9 x 1.0 cm, showed increased activity on recent PET, and is suspicious for metastasis. Additional bilateral smaller nodules are also suspicious for metastases.MEDIASTINUM AND HILA: Several non-specific subcentimeter mediastinal lymph nodes are present. CHEST WALL: Right-sided chest port is present with the catheter tip at the SVC-atrial junction.ABDOMEN:LIVER, BILIARY TRACT: Multiple low-attenuation lesions are present in both lobes of the liver compatible with metastases. An example lesion in segment 8 (series 3, image 93) measures 2.1 x 2.4 cm, unchanged from the prior exam. Additional lesions also similar to prior.Cholelithiasis. Gallbladder is collapsed. SPLEEN: Mild splenomegaly appearing similar to prior.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Numerous enlarged lymph nodes are present in the cardiophrenic, portacaval, gastrohepatic, and paraortic regions which showed increased activity on recent PET and are compatible with metastases. For example periportal lymph node (series 3, image 15) measures 1.7 x 2.2 cm, unchanged. Left periaortic lymph node (series 3, image 118) appears to have increased in size. Some of the lymph nodes have low attenuation centers which may be related to necrosis and/or treatment effect. BOWEL, MESENTERY: Postsurgical changes to the right colon and sigmoid colon. Normal caliber bowel without evidence of obstruction.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No pelvic lymphadenopathy by size criteria.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: A small amount of free fluid is present in the pelvis. | 1.Postsurgical changes to the colon.2.Metastatic lesions to the liver, abdominal lymph nodes, and lungs. Some retroperitoneal lymph nodes have increased in size compared to the prior outside examination.3.Cholelithiasis. |
Generate impression based on findings. | Male 46 years old Reason: metastatic colon CA to liver History: re-staging CHEST:LUNGS AND PLEURA: No suspicious nodules or masses. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: Heart size is normal without pericardial effusion. No hilar or mediastinal lymphadenopathy. Right central venous catheter with tip in the cavoatrial junction.CHEST WALL: Nonspecific, mildly enlarged cardiophrenic lymph node which is unchanged.ABDOMEN:LIVER, BILIARY TRACT: Redemonstrated are multiple bilateral calcified hepatic lesions which are stable to slightly decreased in size. Reference segment 8 lesion is slightly decreased in size and measures 2.9 x 2.6 cm (series 3, image 76), previously 3.2 x 2.8 cm.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Calcified peripancreatic lymph nodes, unchanged.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Suture material in the midline anterior abdominal wall.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: Enlarged prostate.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical changes in the region of the sigmoid colon consistent with prior sigmoid colon resection.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Stable examination with diffuse, bilateral calcified hepatic lesions consistent with patient's history of metastatic colonic adenocarcinoma. |
Generate impression based on findings. | Reason: 3 month follow up for lung nodules History: lung nodule LUNGS AND PLEURA: Moderate apical predominant centrilobular emphysema.A right lower lobe irregularly-shaped solid nodule measures 12 x 11 mm (series 5, image 170), previously measuring 7 x 8 mm. An adjacent small peribronchial nodule measuring 6 x 5 mm (series 5, image 172) is new from the prior exam.A previously described peripheral right upper lobe ill-defined area of ground glass measures 16 x 16 mm (series 4, image 32), unchanged from 2008, likely benign in etiology.Minimal basilar subsegmental atelectasis/scarring.No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. No visible coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative disease of the thoracic spine. Healed right-sided rib fractures, unchanged.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Right hepatic lobe hypodensity is unchanged, likely a benign cyst. | Continued increase in size of a 12-mm right lower lobe solid nodule. Findings suspicious for malignancy, including primary lung neoplasm. PET imaging is recommended for additional evaluation. |
Generate impression based on findings. | Male; 78 years old. Reason: tonsillar cancer; compare to previous with measurements. CHEST:LUNGS AND PLEURA: Scattered calcified and noncalcified micronodules, not significantly changed. No suspicious pulmonary nodules or masses. Diffuse bronchial wall thickening, tree-in-bud opacities, and multifocal areas of nodular/ground glass opacity with superimposed consolidation in the left lower lobe. Findings are compatible with progressing aspiration and superimposed focal infection. Dependent atelectasis is unchanged. No significant pleural effusions.MEDIASTINUM AND HILA: Left infrahilar lymph node with central low density measures 16 mm, previously 17 mm (series 3, image 54). No additional significant lymphadenopathy. Normal heart size without pericardial effusion. Mild aortic and mitral annular calcification.CHEST WALL: Spinal degenerative changes with multiple compression deformities, unchanged.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Scattered benign cysts. Cholelithiasis. No biliary ductal dilatation.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Atrophic kidneys with large bilateral renal cysts, left greater than right.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted. Gastrojejunostomy tube in place.BONES, SOFT TISSUES: Stable L2 compression deformity. Fat containing umbilical hernia.OTHER: No significant abnormality noted. | 1.Stable left infrahilar index lymph node with probable central necrosis, suspicious for metastatic disease.2.No new sites of disease identified. 3.Findings compatible with worsening aspiration as described above, with new superimposed focal infection in the left lower lobe. |
Generate impression based on findings. | Reason: h/o HNC and CRT, compare to previous measurements History: none CHEST:LUNGS AND PLEURA: No suspicious nodules or pleural effusions.MEDIASTINUM AND HILA: No significant lymphadenopathy and no pericardial effusion.Mild coronary artery calcification.CHEST WALL: A soft tissue nodule in the right breast (series 3/24) measures 24 mm in length and is unchanged since at least 2012, and presumably benign.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | No evidence of metastases or other significant change. |
Generate impression based on findings. | Ms. Braun submitted outside mammograms dated 05/6/2014 and 11/11/2009, from Advanced Medical Imaging Center. Submitted outside studies were compared to the current mammogram dated 02/05/2015. The breast parenchyma is composed of scattered fibroglandular elements. Scattered benign calcifications are present in both breasts. No suspicious masses, microcalcifications or areas of architectural distortion are present. There is no significant change between these two studies. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, routine screening mammogram is recommended annually, due next in Feb 2016.BIRADS: 1 - Negative.RECOMMENDATION: NSB - Screening Mammogram. |
Generate impression based on findings. | History of metastatic prostate cancer. Restaging scans. Foci of increased uptake are noted in the posterior left 10th rib and T10 vertebral body, similar to the prior study. Increased uptake of the cortex of the bilateral extremities is suggestive of hypertrophic osteoarthropathy, similar to the prior study. No new osteoblastic lesion is identified.Degenerative uptake is noted in the knees and shoulders. | Stable metastatic osseous lesions without evidence of new lesions. |
Generate impression based on findings. | 36-year-old male patient with history of Kaposi sarcoma including lesion at the gastroesophageal junction/cardia diagnosed and subsequently treated presents with persistent dysphasia. Scout radiograph of the chest showed no mediastinal widening or pleural effusions. Possible scarring noted in the right middle lobe.Double contrast evaluation of the esophagus and gastric cardia/fundus revealed no morphologic abnormalities of the mucosal surfaces or mural contours. Specifically, no mucosal lesions were identified in the area of the gastroesophageal junction and cardia. The is debris in the stomach, which is of uncertain clinical significance given the rapid transit through the stomach and patient's NPO status prior to the examination. During the exam, no spontaneous or provoked gastroesophageal reflux was observed. Fluoroscopic evaluation of esophageal peristalsis demonstrated cessation of the primary wave at the level of the aortic arch with proximal escape and tertiary waves.Lastly, a 13-mm barium pill was given and there is no significant delay in transit into the stomach.TOTAL FLUOROSCOPY TIME: 5.13 minutes. | 1.Minor esophageal motility abnormality.2.No esophageal stenoses or lesions identified. |
Generate impression based on findings. | Reason: h/o HNC and CRT, compare to previous measurements History: none LUNGS AND PLEURA: No suspicious pulmonary nodules or masses.No pleural effusions.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy.Cardiac size is normal evidence of pericardial effusion.CHEST WALL: Mild degenerative changes in the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | No interval change. No evidence of metastatic disease. |
Generate impression based on findings. | 29 years, Male. Reason: SBO History: abd pain/distention Multiple surgical clips project over the right lower lung. Left lung opacity. Several dilated loops of small bowel measuring up to 3 cm with relative paucity of bowel gas distally. No free air. Vascular catheter tip projects over L2-L3 vertebral body. IVC filter is noted. Cholecystectomy clips are noted in the right upper quadrant. | Findings consistent with a small bowel obstruction. |
Generate impression based on findings. | Female 81 years old Reason: History of left shoulder arthroplasty fall 1 month ago History: History of left shoulder arthroplasty fall 1 month ago. Hardware components of a left total shoulder arthroplasty device are situated in near anatomic alignment with no radiographic evidence of fracture or hardware complication. Slight widening of the acromioclavicular joint is likely postoperative in etiology. An approximately 1 cm ossicle located beneath the coracoid process likely represents a loose body. | Total shoulder arthroplasty as described above without evidence of fracture-dislocation. |
Generate impression based on findings. | 75 years, Male. Reason: confirm placement of ureteral stent and any evidence of nephrolithiasis? History: patient reports having ureteral stent for nephrolithiasis and has indwelling Foley, came in with GNR bacteremia Urinary bladder catheter is noted. Overlying bowel gas limits evaluation of the kidneys, however, no abnormal calcifications are seen to suggest nephrolithiasis. No ureteral stent is seen. Nonobstructive bowel gas pattern. Left lower lung atelectasis/consolidation. | No ureteral stent or definite nephrolithiasis. |
Generate impression based on findings. | Reason: evaluate for metastasis. History: ewing sarcoma. LUNGS AND PLEURA: Stable postoperative changes in the lingula.No new suspicious pulmonary nodules or masses.MEDIASTINUM AND HILA: No hilar or mediastinal lymphadenopathy identified.Right chest Port-A-Cath with its tip in the SVC.Cardiac size is normal without evidence of pericardial effusion.CHEST WALL: Status post left chest wall reconstructive changes and stabilization hardware.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | No interval change without evidence of recurrent or metastatic disease. |
Generate impression based on findings. | Male 79 years old Reason: rule out fracture History: pain and tenderness from a fall this morning. There is a step-off along the cortex of the lateral femoral epicondyle compatible with a nondisplaced fracture. There is also a nondisplaced hairline fracture the fibular neck. There is a small joint effusion. | Nondisplaced fractures of the lateral epicondyle of the distal femur and the fibular neck.These findings were verbally relayed to Gabriella Borrelli, at 1400 on 2/24/2015. |
Generate impression based on findings. | Frontal sinus: Interval improvement in the aeration of the near complete opacification of the right frontal sinus and frontoethmoidal recess. Interval improvement in the aeration of the near completely opacified diminutive left frontal sinus and frontoethmoidal recess.Anterior ethmoids: Bilateral ethmoidectomies. No significant interval change in the near complete opacification of bilateral anterior ethmoid air cells, left greater than right. Maxillary sinuses. Bilateral maxillary antrostomies are now more widely patent. Interval improvement in the mucosal thickening of the right maxillary sinus with hyperdense material within it. Interval improvement in the mucosal thickening of the left maxillary sinus.Posterior ethmoids: Interval improvement in the aeration of bilateral posterior ethmoid cavities.Sphenoid sinus: Bilateral sphenoidotomies with interval improvement in the bilateral sphenoid sinus aeration with persistent moderate mucosal thickening, left greater than right.No significant nasal septal deviation. The lamina papyracea are intact. | Postsurgical changes with interval improvement in the aeration of the paranasal sinuses as above. |
Generate impression based on findings. | Left shoulder pain for many months. Evaluating for degenerative joint disease. Mild osteoarthritis affects the glenohumeral joint. I see no acute fracture or malalignment. | Mild glenohumeral joint osteoarthritis. |
Generate impression based on findings. | 55 years, Female. Reason: abdominal pain with hyperactive bowel sounds History: abdominal pain with hyperactive bowel sounds Slightly greater than average stool burden in the ascending and transverse colon. Nonobstructive bowel gas pattern. | Nonobstructive bowel gas pattern with slightly greater than average stool burden in the ascending and transverse colon. |
Generate impression based on findings. | There are unchanged postoperative findings of neck dissection in the left neck. No discrete mass in the oropharynx. There is a stable left tracheoesophageal groove enhancing nodule measuring 7 mm in short axis on series 6 image 64 just behind the left thyroid lobe posteriorly. Otherwise, there is no recurrent mass or significant cervical lymphadenopathy. The thyroid and major salivary glands are unremarkable. The major cervical vessels are patent. The osseous structures show no focal lesions. There are endplate and uncovertebral osteophytes at C3-4 through C6-7 with up to moderate spinal canal stenosis at C4-5. The airways are patent. The imaged intracranial structures are unremarkable. There is a right maxillary sinus polyp versus mucous retention cyst. Please refer to dedicated accompanying CT chest report for further details. | 1. No evidence of locoregional tumor recurrence or cervical lymphadenopathy.2. Enhancing nodule in the left tracheoesophageal groove is favored to represent a parathyroid adenoma and less likely lymph node.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | Middle finger, post traumatic arthritis of the PIP joint. There is severe osteoarthritis of the PIP joint of the middle finger with mild deformity of the underlying bone compatible with the stated history of prior trauma. The PIP joint is held in slight flexion and there is mild surrounding soft tissue swelling. Relatively mild osteoarthritis affects the distal interphalangeal joint. | Severe osteoarthritis of the PIP joint. |
Generate impression based on findings. | 72 years, Male. Reason: Constipation History: R/O Ileus Multiple dilated loops of small and large bowel, compatible with an ileus type pattern. Partially visualized enteric feeding tube is looped in the stomach with tip projecting over the gastric fundus.Lower pelvis is excluded from field of view. | Findings compatible with ileus type bowel gas pattern. |
Generate impression based on findings. | 70 year old male with dysphagia, regurgitation; history of Hodgkin's lymphoma s/p radiation in 1975 with stricture diagnosed 10 years ago. Scout radiograph of the chest showed bibasilar opacities and a right pleural effusion. Calcified granulomas are also noted.Test swallows of contrast demonstrated preferential flow of contrast through the left (series 3 cine). Vestibular penetration was noted without evidence of frank tracheal aspiration. Single contrast evaluation of the esophagus demonstrated a distensible esophageal web or kinking narrowing the esophagus up to 5 mm (series 15). There is an arrest in the primary peristaltic wave at this level with proximal escape of contrast at this level. In the distal esophagus, there is a short segment stenosis narrowed to 3 mm in diameter causing delay in transit of contrast. On several spot images, a linear opacification adjacent to the esophagus measuring at least 4 mm is seen suggestive of a intramural fistula or tract. No connection to adjacent structures are noted.A duodenal diverticulum was incidentally noted.TOTAL FLUOROSCOPY TIME: 4:55 minutes | 1.Short segment stenosis in the distal esophagus with adjacent intramural fistula versus tract. 2.Distensible esophageal web or kinking of the cervical esophagus narrowing the esophagus as described above.3.Mild motor abnormality as described above. 4.Preferential flow of contrast to the left suggestive of right sided weakness. Consider OPM study. 5.Vestibular penetration without evidence of tracheal aspiration. Consider OPM study. |
Generate impression based on findings. | Reason: r/o PE History: CP PULMONARY ARTERIES: No evidence of pulmonary embolism. The main pulmonary artery is normal in caliber.LUNGS AND PLEURA: Scattered benign-appearing micronodules, some calcified. No suspicious pulmonary nodules or masses.Mild pleural scarring in subsegmental cysts/scarring. No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is mildly enlarged, without pericardial effusion. No visible coronary artery calcification.Scattered calcified mediastinal and hilar lymph nodes, from prior granulomatous disease. A right hilar lymph node measures 1.4 cm (series 7, image 110).CHEST WALL: Status post left mastectomy, left axillary lymph node dissection. Degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Status post cholecystectomy. | 1. No evidence of pulmonary embolism or other acute abnormality to account for the patient's symptoms.2. Mildly prominent hilar lymph nodes with calcifications, likely from prior granulomatous disease. No definite evidence of metastatic disease.PULMONARY EMBOLISM: PE: Negative.Chronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | Pain status post PIP arthroplasties There are arthroplasty devices at the PIP joints of the index, middle, and ring fingers. Ulnar angulation/subluxation of the middle phalanges relative to the proximal phalanges of index and middle fingers is more pronounced on the current study than on the prior study. The PIP joint of the ring finger is held in flexion, but the hardware components are otherwise in near-anatomic alignment. Osteoarthritis affects the remaining interphalangeal joints. The bones appear demineralized. | PIP joint arthroplasties as described above, with ulnar angulation/subluxation of the middle phalanges of the index and middle fingers. |
Generate impression based on findings. | Right total knee arthroplasty. Lumbar spine fusion. LUMBAR SPINE: The bones are demineralized. Again seen are rods with screws entering the L1 to S1 vertebrae, with additional screws entering the iliac wings. Lucency around the L1 screws appears more prominent on the current study compared to prior. The tips of the L1 screws overlie the superior endplate of L1. Otherwise we see no radiographic evidence of hardware complication. A disk spacer is noted at L5/S1. Severe degenerative disk disease affects the remainder of the lumbar spine. There is slight rightward curvature of the lumbar spine, appearing similar to prior. Bone graft is seen along the lateral aspects of the lumbar spine, appearing similar to prior. The T12 vertebra is unremarkable.RIGHT KNEE: Four views of the right knee demonstrate hardware components right total knee arthroplasty device situated in near-anatomic alignment without radiographic evidence of hardware complication. Anterior soft tissue swelling limits evaluation of the extensor mechanism.A left total knee arthroplasty device appears in near anatomic alignment as seen on the frontal views. | Postoperative changes of total knee arthroplasties and lumbar spine fixation, as above. |
Generate impression based on findings. | 71 years, Female. Reason: incontinence History: as above Nonobstructive bowel gas pattern. Slightly less than average stool burden in the colon. Vascular calcifications are noted and numerous phleboliths project over the pelvis. | Nonobstructive bowel gas pattern with slightly less than average stool burden in the colon. |
Generate impression based on findings. | Female; 61 years old. Reason: ILD History: cough and dyspnea. LUNGS AND PLEURA: Nonspecific scattered micronodules, not significantly changed from previous. Basilar predominant lucent lobules, architectural distortion, and mild traction bronchiectasis are noted, but there is no definite honeycombing. Subpleural reticulation and air trapping on expiration images are also present, not significantly changed. No pleural effusions or focal areas of consolidation. MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. No significant mediastinal or hilar lymphadenopathy. Severe coronary calcifications. Enlarged main pulmonary artery diameter, suggestive of PA hypertension. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. Status post cholecystectomy. | Findings indicative of fibrosis, including subpleural reticulation, architectural distortion, and lucent lobules in the lung bases. While nonspecific, these findings are compatible with hypersensitivity pneumonitis. |
Generate impression based on findings. | Wrist fusion Two views of the right forearm and three views of the right wrist demonstrate a plate and screw device affixing an osteotomy of the distal ulnar diaphysis in near-anatomic alignment. The osteotomy margins are slightly indistinct, indicating some healing.An orthopedic screw affixes a the lunate and triquetrum in anatomic alignment. Orthopedic staples affix the capitate and hamate, the bases of the third and fourth metacarpals, the third carpometacarpal joint, and the fourth carpometacarpal joint in near anatomic alignment. The third and fourth carpometacarpal joints are indistinct, which may reflect early fusion, however this is equivocal. Small densities between the bases of the third and fourth metacarpals and along the dorsal aspect of the carpus presumably represent bone graft material. | Orthopedic fixation of the distal ulna and wrist, as described above. |
Generate impression based on findings. | 60 year old with history of right lumpectomy in 2011 for DCIS followed by radiation therapy. History of benign left breast stereotactic core biopsy in January of 2012. No new breast complaints. History of breast carcinoma in maternal great aunt and ovarian carcinoma in paternal grandmother. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD, 9.3. The breast parenchyma is heterogeneously dense, unchanged in pattern and distribution. Stable postsurgical architectural distortion, skin retraction and surgical clips are present in the right lumpectomy bed. Metallic clip from percutaneous biopsy of the left breast is unchanged in position. 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. | 54-year-old female with history of sinonasal melanoma. CHEST:LUNGS AND PLEURA: Right lower lobe reference nodule now measures 1.1 x 1.2 cm (series 9, image 47), previously 1.1 x 1.2 cm. Adjacent conglomerate of perifissural nodules (series 9, image 45) measures 2.4 x 3.3 cm, previously 1.9 x 3.3 cm. MEDIASTINUM AND HILA: Multinodular thyroid. Right hilar node (series 7, image 37) now measures1.2 x 1.4 cm, previously measuring 1.2 x 1.4 cm.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: There is no evidence of biliary ductal dilatation or focal mass lesion within the hepatic parenchyma. Portal vein is patent. 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: Soft tissue mass with central necrosis located anterior and inferior to the pancreas, which is inseparable from the pancreatic parenchyma has decreased in size, now measuring 5.1 x 5.3 cm (series 7, image 101), previously 6.3 x 6.3 cm. There is continued complete occlusion of the SMV as it courses through the posterior aspect of this mass. There is associated collateral formation.BOWEL, MESENTERY: The exophytic mass arising from the lesser curvature the stomach (series 7, image 82) measures 4.5 x 4.5 cm, previously measuring 5.6 x 7.5 cm. BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See aboveBONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Pulmonary metastases stable to slightly increased in size. 2.Interval decrease in size of peripancreatic and gastric metastases. SMV remains occluded. |
Generate impression based on findings. | 54-year-old female with a history of left mastectomy June 2013 for breast cancer. Family history of breast cancer in maternal grandmother and ovarian cancer in mother. 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 retroareolar mass has decreased in size. 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, right unilateral 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. | Male 27 years old Reason: Multiple surgical teams. History: RFO. We have a frontal view of the right tibia/fibula which was performed in the OR. We see no unexpected retained radiopaque foreign object. There are skin staples, surgical clips, and drains noted within the soft tissues as well as foci of gas density reflecting recent surgery. | Postoperative changes as above without radiographic evidence of retained radiopaque foreign object.These findings were discussed by telephone with Dr. Haydon, the attending surgeon, on 2/24/2015 at 1433. |
Generate impression based on findings. | Follow-up An oblique fracture traverses the distal fibula, with approximately 1 cortical width of lateral displacement of the distal fracture fragment. Soft tissue swelling is present, particularly at the lateral aspect of the ankle. | Distal fibular fracture, as above. |
Generate impression based on findings. | Osteoarthritis of the knee RIGHT KNEE: Severe osteoarthritis affects the right knee, predominantly at the lateral compartment. There is mild valgus angulation at the knee. A large joint effusion is present. Meniscal chondrocalcinosis is noted. Venous varicosities are present in the medial soft tissues.LEFT KNEE: Severe osteoarthritis affects the patellofemoral joint. Moderate osteoarthritis affects the tibiofemoral compartments. A large joint effusion is present. Meniscal chondrocalcinosis is noted. An ossicle adjacent to the medial femoral condyle likely reflects old MCL injury. | Degenerative changes of the knee reflecting a combination of osteoarthritis and CPPD arthropathy. |
Generate impression based on findings. | Ms. Raudabaugh is a 58 year old female with a personal history of left breast lumpectomy in December 2008 for IDC followed by radiation and chemotherapy. Personal history of bilateral benign breast biopsies. Family history of breast cancer in mother diagnosed at the age of 56. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. A linear marker was placed on the scar overlying the left breast. There are stable postsurgical changes including architectural distortion, increased density, and surgical clips present within the left lumpectomy site. Bilateral benign biopsy clips are present (two in the right and one in the left), from prior benign breast biopsies. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | Stable postsurgical changes of the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Metastatic prostate cancer. Evaluate for disease progression. Again demonstrated are multiple osseous metastases of the axial and proximal appendicular skeleton, including the right proximal humerus, midthoracic spine and adjacent posterior ribs, lower thoracic spine, and lumbar spine. There has been interval enlargement of the lesions in the left thoracic medial posterior ribs and upper thoracic spine as well as the right humerus. One new lesion is noted in the lower left anterior segment of the ribs, which can be due to fracture or tumor. A questionable new lesion is noted in the upper cervical spine. Just inferior to the known lower lumbar lesion is a questionable new lumbar lesion. | Probable progression of the metastatic osseous disease. |
Generate impression based on findings. | Reason: HNSCC. Compare to previous. History: as above CHEST:LUNGS AND PLEURA: Surgical changes of right upper lobe resection and postradiation reaction, appearing similar to the prior exam.A new left lower lobe focus of consolidation with surrounding tree in bud opacities (series 5, image 83), with new associated bronchial opacification, compatible with aspiration/mucus plugging and associated pneumonia and bronchiolitis.Additional scattered ground glass and tree in bud opacities, compatible with aspiration and bronchiolitis, appear similar to the prior exam.No new suspicious pulmonary nodules or masses.New very small left pleural effusion.MEDIASTINUM AND HILA: The heart is normal in size. Severe coronary artery calcifications are present. No significant pericardial effusion.Mild diffuse circumferential esophageal wall thickening, stable.Tracheostomy tube in place.Enlarged mediastinal nodes appear similar to the prior exam.Reference low right paratracheal lymph node measures 13 mm (series 3, image 32), unchanged.Reference subcarinal lymph node measures 15 mm (series 3, image 47), unchanged.CHEST WALL: Right chest port, the SVC.Mild degenerative disease of the thoracic spine.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: Previously described gallbladder wall thickening is improved.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: Left hypodense adrenal nodules appear unchanged. The left adrenal gland measures 4.1 x 1.6 cm (series 3, image 101), unchanged.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Atherosclerotic calcification of the abdominal aorta and its branches.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Postsurgical changes in the lower lumbar spine.OTHER: No significant abnormality noted. | 1. New left lower lobe aspiration/mucus plugging and associated pneumonia and bronchiolitis. This is too rapid an evolution for tumor. Additional scattered findings of aspiration/bronchiolitis are not significantly changed.2. No new suspicious pulmonary nodules or masses.3. Mild esophageal wall thickening, mediastinal lymphadenopathy, and post-treatment changes in the lungs appear unchanged. |
Generate impression based on findings. | Cough feverVIEWS: Chest AP and lateral Cardiothymic silhouette normal. Cardiac apex and stomach left-sided. Peribronchial wall thickening with subsegmental atelectasis in the right lower lobe. No pleural effusion or pneumothorax. | Bronchiolitis or reactive airway disease. |
Generate impression based on findings. | 65 years, Male. Reason: 65M with AML, now intubated with OGT placed for AMS/hypoxia, ?OGT placement History: 65M with AML, now intubated with OGT placed for AMS/hypoxia, ?OGT placement Nasogastric tube side-port projects over the gastric cardia with tip over the proximal gastric body. Nonobstructive bowel gas pattern. Radiopacity projecting over the right hemiabdomen may represent a renal calculus. Note that the pelvis is excluded from the field-of-view. | NG tube tip projects over the proximal gastric body. |
Generate impression based on findings. | 43 years, Female. Reason: Dobbhoff History: Dobbhoff LVAD device, multiple surgical drains and tubes, and cardiac leads are noted. Dobbhoff tube tip projects over the first portion of the duodenum. Guide wire is still in place. Moderate amount of amorphous stool is noted within the rectum and sigmoid colon. Nonobstructive bowel gas pattern. Note that the lower pelvis is excluded from the field-of-view. | Dobbhoff tube tip projects over the first portion of the duodenum. |
Generate impression based on findings. | 2-year-old male with history of Blount's diseaseVIEWS: Standing mechanical axis exam of the lower extremities. 2/24/15 11:28 Bilateral genu varus deformity is again identified. There is thickening of the medial cortices of the femurs and tibias. The tibial metaphyseal diaphyseal angle on the right is 5 degrees and on the left is 6 degrees. There is minimal beaking and depression of the medial aspect of the proximal tibial metaphyses. | Physiologic bowing deformities as described above. |
Generate impression based on findings. | 59 years, Male. Reason: eval dobhoff position History: repositioned NG tube tip projects over the distal gastric body. Dobbhoff tube is looped over the stomach and the tip is obscured by overlying enteric contrast. Enteric contrast is pooled in the gastric fundus and body. | Dobbhoff tube is looped over the stomach with tip obscured by overlying enteric contrast in the stomach. |
Generate impression based on findings. | Ms. Starman is a 68 year old female with a personal history of right breast mastectomy in June 2014 for extensive DCIS. She has no current breast related complaints. Three standard views of the left breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Two vascular clips are seen in the left upper inner breast. Scattered benign calcifications are stable. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in the left breast. | No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, left unilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 1 - Negative.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | 56 years, Male. Reason: bowel pattern History: patient will be having peg placed Nonobstructive bowel gas pattern. Surgical clips project over the left hemipelvis. Penile implant and calcified seminal vesicles again noted. | Nonobstructive bowel gas pattern. |
Generate impression based on findings. | Male 19 years old Reason: healed scaphoid fracture History: none. An orthopedic screw affixes the fracture of the proximal aspect of the scaphoid waist in near-anatomic alignment. While portions of the fracture remain visible, there appears to be bony union across the majority of the fracture plane, indicating healing. The proximal fracture fragment appears slightly more dense than the remainder of the scaphoid, but we are not certain if this represents early avascular necrosis or simply a manifestation of healing.A small sclerotic density in the lunate bone likely represents a benign bone island; the carpal bones otherwise appear normal. The visualized soft tissue structures appear normal within the limitations of a non-arthrogram study. | Orthopedic fixation of healing scaphoid fracture as above. |
Generate impression based on findings. | Female 36 years old Reason: r/o fx History: fall. AP view of the pelvis and two views of the left hip show no acute fracture. Postoperative changes of a left total hip arthroplasty removal and cement spacer placement appear similar to those seen on the prior study. Components of a right total hip arthroplasty device are situated in near anatomic alignment, although the distal extent of the prostheses is not included on the field of view on this study. The bones are demineralized.We have 4 views of the lumbar spine. The bones are demineralized compatible with sickle cell disease. There is central endplate depression of the vertebrae with mild loss of height likely the result of endplate infarction that we suspect is chronic in etiology. The alignment is within normal limits. | Postoperative changes and findings compatible with sickle cell anemia as described above. We see no acute fracture. |
Generate impression based on findings. | Female 33 years old Reason: flank pain, renal stones, hx of nephrolithiasis History: as above Limited exam secondary to lack of intravenous contrast. Evaluation of solid organ and vascular pathology is suboptimal.ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Acute obstructing renal calculus measuring up to 6 mm in the axial dimension (series 3, image 78) at the left ureteropelvic junction with moderate left hydronephrosis. There are additional smaller, nonobstructing renal calculi in left kidney. No right hydronephrosis. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: Trace free pelvic fluid which is likely physiologic. | Obstructing 6 mm calculus at the left ureteropelvic junction with associated moderate left hydronephrosis. |
Generate impression based on findings. | 66 years, Male. Reason: G tube study History: G tube study Gastrostomy tube projects over the gastric body. Enteric contrast is noted pooling in the fundus. Colonic ileus is again noted without pneumoperitoneum. | Gastrostomy tube projects over the gastric body with enteric contrast in the fundus. |
Generate impression based on findings. | intractable seizure This is a surgical/treatment planning exam and not a diagnostic test.Examination is performed while a stereotactic device is secured to the calvarium without detectable complication.There are multiple linear devices inserted through multiple burr holes including, right frontal, right temporal and right occipital lobes, All devices were located right hippocampus and body of parahippocampal gyrus.There is no evidence of associated hemorrhage or ischemic lesion on this scan, although precise evaluation is not possible due to significant metallic artifacts.There is revisualization of a cavum septum pellucidum and vergae, No gross intracranial abnormality is identified. Unremarkable orbits, paranasal sinuses and the mastoid air cells. Calvarium and soft tissues of the scalp are unremarkable. | Post device insertion status CT scan. Post procedure no unusual finding although precise evaluation is not possible due to multiple metallic artifacts. |
Generate impression based on findings. | 2-year-old male postop cochlear implant placementVIEWS: Skull AP and lateral (two views) 2/24/2015 The leads of the bilateral cochlear implants are coiled within the expected location of the cochlea bilaterally. No evidence of hardware failure. | Leads are coiled within the expected location of the cochlea bilaterally. |
Generate impression based on findings. | Reason: history of lumbar fusion. assess bony fusion History: history of lumbar fusion, assess lumbar fusion Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall height. There is mild anterior subluxation of L4 on L5. There is a levocurvature present to the lumbar spine. There is right lateral translation of the L3 on L4. There is a rotatory curvature to the lumbar spine present.The patient is status post fusion of the spinous processes at L4-5. The metallic hardware is located behind the spinous process of L4 and across the spinous process of L5. A spacer is present located immediately behind the spinous process of L4.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, endplate osteophytes and osseous bridging at the disk space at this level associated with bilateral narrowing of the neural foramina encroachment of right-sided exiting nerve roots within the neural foramina. There is a mild to moderate degree of facet hypertrophy at this level right more than left. There is osseous bridging across the right facet joint of L5-S1.At L4-5 the patient is status post L4-5 intraspinous fusion. The L4 spinous process is located anterior to the metallic hardware. Anterior subluxation of L4 on L5 has increased from approximately 4 mm to 8 mm. there is marked bilateral facet hypertrophy present at this level associate diffuse disk bulge and effacement of the fat of the lateral recesses there is a moderate to severe degree of spinal stenosis present at this level. There is encroachment of the exiting nerve root the neural foramina bilaterally at this level with encroachment of the right-sided exiting nerve roots. There is mild left lateral translation of L4 on L5.At L3-4 there is loss of disk space height and diffuse disk bulge associated with facet and ligamentum flavum hypertrophy. There is partial effacement of the fat of the lateral recesses at this level and overall in moderate degree of spinal stenosis the exiting nerve roots within the neural foramina are surrounded by fat. There is mild right lateral translation of L3 on L4At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.There is vacuum joint phenomenon present within the sacroiliac joints. | 1.Status post spinous process fusion at L4-5 as detailed above. The L4 spinous process is situated adjacent and anterior to the hardware. There is no osseous bridging appreciated.2.There is a moderate degree of spinal stenosis at L4-5 associated with subluxation and facet hypertrophy as well as encroachment of the right-sided exiting nerve roots the neural foramina. The subluxation has mildly progressed when compared to the prior MRI exam.3.There is a moderate degree of spinal stenosis present at L3-4 related to degenerative changes. |
Generate impression based on findings. | Ms. Simms is a 57 year old female with a personal history of bilateral benign breast biopsies and bilateral calcifications. She has no current breast related complaints. Three standard views of both breasts and two left spot magnification views were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is heterogeneously dense, which may obscure small masses, unchanged in pattern and distribution. Spot magnification views were performed of the left superior breast demonstrating a benign progression of punctate calcifications. Additional scattered calcifications are present in both breasts. There is redemonstration of at least four partially circumscribed masses in the left breast, many of which demonstrate coarse benign calcifications, and are stable over multiple prior exams. There is no new mass, suspicious microcalcifications or areas of architectural distortion identified in either breast. | Stable benign morphology masses in the left breast. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Markedly enlarged hilar and mediastinal adenopathy in 12/2014. Persists after treatment for new CHF. Biopsy proven UIP noted in the pathology report from July of 2013.RADIOPHARMACEUTICAL: 12.7 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 98 mg/dL. Today's CT portion again demonstrates extensive bibasilar predominant fibrotic changes including honeycombing and architectural distortion. Please refer to the recent previous chest CT for more in depth description of the lung findings. Again seen is nonspecific mediastinal and hilar lymphadenopathy appearing unchanged in size as far back as 3/23/2012.Today's PET examination demonstrates moderately increased FDG avid activity within the mediastinal and hilar lymph nodes. The most active lymph node which is within the peri-tracheal region has an SUVmax of 9. Minimal FDG uptake is noted in the diffuse interstitial changes. | Despite the high FDG activity of the lymph nodes within the mediastinum, the lymph nodes have not changed in size in 3 years. Therefore this activity more likely represents UIP or other inflammatory condition. Minimally increased metabolic activity in the interstitial lung opacities. |
Generate impression based on findings. | FractureVIEWS: Left elbow AP and lateral There is a healing supracondylar fracture in near anatomic alignment. Periosteal reaction and sclerosis are present indicative of healing. The metallic hardware has been removed in the interval. No evidence of elbow joint effusion. | Healing supracondylar fracture as described above. |
Generate impression based on findings. | 11 year old female with right ankle sprain. Evaluate for fracture.VIEWS: Right ankle AP, oblique and lateral (3 views) 2/24/2015 Normal alignment. No evidence of joint effusion. No evidence of fracture or dislocation. | Normal examination. |
Generate impression based on findings. | Male 67 years old Reason: 67 yo male with history of acute pancreatitis in October 2012, with pancreatic duct calcifications seen on EUS, s/p ERCP 2/24/15 with attempted removal of stones but unsuccessful. Pancreas protocol CT to determine stone location for surgery referral History: pancreatic duct stones, with complaints of post prandial abdominal pain Limited exam secondary to residual contrast from ERCP from the same day.ABDOMEN:LUNG BASES: Bibasilar and lingular reticular pattern likely representing atelectasis/scarring. Pulmonary nodule in the left major fissure measuring up to 7 mm likely representing an intrapulmonary lymph node (series 4, image 21). Additional nonspecific subpleural nodule in the right lower lobe measuring up to 7 mm (series 4, image 22).LIVER, BILIARY TRACT: Multiple hypodense lesions in the liver without enhancement which are nonspecific but favor benign etiology such as hepatic cysts. Limited exam secondary to residual contrast from ERCP from the same day which makes delineation of common bile duct stones suboptimal. Within these limitations, there is a focus with increased attenuation in the distal common bile duct which may represent a stone in the seen on coronal images measuring 0.7 x 1.5 cm (series 80880, image 63).SPLEEN: No significant abnormality notedPANCREAS: Multiple calcifications throughout the pancreas with pancreatic dilatation consistent with history of prior pancreatitis. ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Cystic lesions adjacent to the upper pole of the left kidney measuring 2.7 x 1.8 cm (series 10, image 54). This lesion may represent a bilobed exophytic cyst.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Degenerative changes of thoracic spine. Small fat containing umbilical hernia.OTHER: No significant abnormality noted | 1.Limited exam secondary to residual contrast from ERCP from the same day. Within these limitations, there is a focus with increased attenuation in the distal common bile duct which may represent a stone.2.Cystic lesions adjacent to the upper pole of the left kidney which may represent a bilobed exophytic renal cyst. Recommend follow-up renal ultrasound to further characterize.3.Bilateral subcentimeter lung nodules which may represent intrapulmonary lymph nodes. Recommend follow-up thoracic CT examination in 6 months to assess stability. |
Generate impression based on findings. | Reason: SVC protocol History: Right arm and face swelling and pain LUNGS AND PLEURA: Bilateral basilar subsegmental atelectasis.Calcified granuloma at the right base.MEDIASTINUM AND HILA: Markedly enlarged thyroid gland with a inhomogeneous mass arising from the left lobe of the gland with cystic areas and calcifications, approximately 10 cm in vertical extent. The inferior margin of the mass extends to the level of the aortic arch. There is marked carotid artery and jugular vein in the jugular vein is severely compressed and narrowed in its inferior course.No significant lymphadenopathy.Severe coronary artery calcification.No pericardial effusion.CHEST WALL: Degenerative disease in the spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Gastrostomy tube in place. Multiple hepatic cysts.Mildly enlarged left adrenal gland measuring 15 mm in diameter.Mildly dilated pancreatic duct, incompletely visualized. | Markedly enlarged inhomogeneous and partially calcified thyroid gland with displacement and compression of the jugular veins, particularly on the left. The nature of the left thyroid mass is indeterminate based on CT and ultrasound could be used for further evaluation if clinically indicated. |
Generate impression based on findings. | 41 year-old female with history of new onset vertigo and headache. There is no evidence of acute intracranial hemorrhage. The gray-white differentiation is preserved. No midline shift or mass effect. The basal cisterns are intact. The ventricles and sulci are symmetric without evidence of hydrocephalus. The imaged paranasal sinuses and mastoid air cells are clear. | No acute intracranial abnormality. If there is continued suspicion for intracranial ischemia, consider MRI 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. | Reason: vertebral artery dissection vs. aneurysm History: headache, ataxia Neck CTA: There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.Atherosclerotic calcifications are present the origins of the vertebral arteries Atherosclerotic calcifications are present at the carotid bifurcations.There are degenerative changes present in the cervical spine with multilevel endplate and uncovertebral osteophytes.Brain CTA: There is opacification of the distal internal carotid arteries, the distal vertebral arteries and the proximal anterior middle and posterior cerebral arteries. No aneurysms or intracranial stenosis is appreciated.The anterior communicating artery and the posterior communicating arteries are identified and are intact. The left A1 segment is larger than the right A1 segment. The left A2 segment is asymmetrically larger than the right A2 segment. There is fetal origin of the right posterior cerebral artery. The right P1 segment is hypoplastic paired the left P1 segment is similar in size but slightly smaller relative to the left posterior communicating artery.There is mild narrowing of the A3 segment of the left pericallosal artery but the finding suggests a stenosis at the A2 segment of the right anterior cerebral arteryIncidental note is made of empty sella. Atherosclerotic calcifications are present along the distal internal carotid arteries.CT head:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are hypodense foci present along the left internal capsule and in the periventricular white matter predominantly in the left side.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. | 1.No evidence for aneurysm.2.Findings suggest a stenosis along the A2 segment of the right anterior cerebral artery.3.No evidence for vertebral dissection. |
Generate impression based on findings. | Female 65 years old Reason: fx? History: fall. We have 3 views of the ribs. Note is made of multiple healed rib fractures bilaterally, but we see no acute rib fracture. The bones are demineralized. There is a posterior stabilization device affixing the thoracic spine and tension wires affixing the sternum. Degenerative arthritic changes affect the spine. There is widening of the left acromioclavicular joint which may be from prior surgery. There is dense calcification of the abdominal aorta and common iliac arteries. Please refer to the accompanying chest radiograph report for details regarding the lungsWe have two views of the left hip. Hardware components of a left total hip arthroplasty device are situated in near anatomic alignment with no radiographic evidence of hardware complication. There is a mild associated deformity of the medial acetabular wall with a traversing linear lucency that we suspect is postoperative in etiology rather than representative of fracture. | Postoperative changes and multiple old healed rib fractures. We see no definite acute fracture. |
Generate impression based on findings. | A 95 year old female with symptomatic critical aortic stenosis referred to cardiac CT for evaluation before TAVR procedure.CPT: 75572 Aortic and Aortic Root. There is a left sided aortic arch with normal brachiocephalic branching pattern. No thoracic aortic dissection or aneurysm is noted. The thoracic aorta has mild tortuosity. No protruding aortic atheroma or thrombus is noted in the thoracic aorta. There is severe calcification of the aortic root. There is moderate calcificaiton of the aortic arch. There is mild calcificaiton of the descending aorta. No aortic coarctation is noted. There is mild to moderate atherosclerosis the proximal brachiocephalic vessels. Aortic Annulus: Dimension: 23mm x 28mm Perimeter: 82mm Area: 5.01cm2Sinus of Valsalva: Width: 27mm x 28mm x 28mm Height: 19mmSinotubular Junction: 24 x 25 mmAscending Aorta (4cm from annulus): 27mm x 28mmMid Aortic Arch: 21 x 212 mmDescending Aorta: 22 x 25 mmAnnulus to LM Height: 18 mmAnnulus to RCA Height: 17 mmAortic Leaflet Length: 15 mmFluoroscopic angle LAO 7 CRA 12Aortic Valve: The aortic valve is trileaflet. There is severe aortic valve calcification, which involves all the three cusps. Mitral Valve: Mild mitral annular calcification which involves both the anterior and posterior leaflets.Left Ventricle: Normal LV size with mild left ventricular hypertrophy. There is no thrombus noted in the left ventricle. The morphology of the interventricular septum is within normal limits. Right Ventricle: The RV is mildly dilated.Left Atrium: The left atrium is severely dilated. There are four distinct pulmonary veins which drain normally into the left atrium. There is a filling defect in the left atrial appendage which could represent either a thrombus or slow flow.Right atrium, vena cavae, and coronary sinus: The right atrium is severely dilated. The superior and inferior vena cavae are dilated. The coronary sinus is normal in size. Pulmonary Artery: Normal in size.Pericardium: No effusionCoronary arteries: Because heart rate management was not attempted and nitroglycerin was not administered, this exam was not performed to optimally visualize the coronary arteries. However within the limitations of the study the following observations are made:LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There is moderate calcification of the left main coronary artery. LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There is severe calcification of the LAD. LCx: The left circumflex coronary artery courses normally in the the left AV groove. It gives rise to the obtuse marginal branches and a small AV circumflex branch. There is severe calcification of the LCx.RCA: The right coronary artery arises normally from the right sinus of Valsalva. It is the dominant coronary artery supplying a posterior descending artery and a posterolateral branch. There is mild calcification of the RCA. Coronary Bypass Grafts:None present. | 1. Severe aortic valve calcification2. Thoracic aorta anatomy as above. 3. Moderate to severe global degree of coronary artery calcification.3. Severe biatrial dilation.4. Mitral annular calcification extends onto the bases of the anterior and posterior leaflets.5. There is a filling defect in the left atrial appendage which could represent either a thrombus or slow flow.This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report. |
Generate impression based on findings. | Reason: mets lung cancer, s/p chemo and RT with residual disease. On Crizotinib now for ALK +. Pls c/w previous outside scan to evaluate tx response. History: lung ca CHEST:LUNGS AND PLEURA: Dense focal radiation reaction and bronchiectasis in the right lower lobe with associated volume loss. Radiation reaction extends to the right perihilar region.Moderate right pleural effusion.MEDIASTINUM AND HILA: Mildly enlarged calcified paratracheal lymph nodes, some of which are calcified, compatible with previous infection.Enlarged subcarinal lymph nodes measuring 18 mm in short axis, not appreciably changed in measurement but subjectively less bulky.Moderate coronary artery calcification.Minimal pericardial effusion.CHEST WALL: No significant abnormality noted.ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.PANCREAS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Absence of enteric contrast material limits sensitivity for GI pathology.No gross abnormalities noted.BONES, SOFT TISSUES: Moderate degenerative disease in the spine.OTHER: No significant abnormality noted. | 1. Dense radiation reaction, bronchiectasis and volume loss in the right lower lobe, with no measurable residual tumor. 2. Moderately enlarged subcarinal lymph nodes, unchanged or possibly decreased. |
Generate impression based on findings. | 41-year-old male with metastatic thyroid cancer. Compare to last CT scan, with measurements. LUNGS AND PLEURA: Innumerable basilar predominant pulmonary nodules in a miliary distribution, not significantly changed and compatible with the patient's known metastatic thyroid cancer. Right lower lobe reference nodule measures 8 x 8 mm, unchanged (series 5, image 161). No pleural effusions or focal areas of consolidation. MEDIASTINUM AND HILA: Normal heart size without pericardial effusion. Severe coronary calcifications. Status post thyroidectomy. Mediastinal lymphadenopathy is again noted, with reference left upper paratracheal lymph node measuring 15 mm(series 3, image 9) and reference paraesophageal lymph node measuring 11 mm (series 3, image 68). Both of these nodes are unchanged in size when using similar measurement technique. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Hepatic steatosis. | No significant interval change in innumerable pulmonary metastases or mediastinal lymphadenopathy. No new suspicious lesions identified. |
Generate impression based on findings. | Bilateral leg pain. Severe degenerative disk disease affects the L5/S1 level. Moderate degenerative disk disease affects the L2/L3 level. Posterior bulging disks are seen at L3/L4 and L4/L5. We see no frank instability on lateral flexion, neutral, and extension views. | Degenerative disk disease without evidence of instability. |
Generate impression based on findings. | Postoperative findings related to thyroidectomy and bilateral neck dissection. The previously noted fairly discrete nodular lesions along the left paratracheal space are much more ill-defined and appear to occupy a greater quantity of space when compared with the previous examination. There is resultant increased displacement of the airway to the right but the airway remains patent. For reference, the left thyroid bed lesion measures 19 x 16 mm, previously measuring 16 x 13 mm. The left tracheoesophageal groove lesion measures 14 x 9 mm (series 7, image 69), previously measuring 12 x 10 mm. The right thyroid bed lesion measures 12 x 10 mm (series 7, image 68), previously measuring 13 x 11 mm. Reference right supraclavicular lymph node measures 10 x 12 mm, unchanged. Multiple scattered bilateral subcentimeter cervical lymph nodes not significantly changed. The right internal jugular vein has been sacrificed.The parotid and submandibular glands are normal in size and symmetric bilaterally without masses. There are no nasopharyngeal, oropharyngeal or laryngeal masses identified. Again noted are numerous small pulmonary nodules. | 1.Lesions along the left paratracheal space have become less well-defined and overall larger. Findings are concerning for disease progression; although, treatment related inflammation may be considered.2.Pulmonary nodules are noted. Please refer to separate CT chest report for additional findings. |
Generate impression based on findings. | Lumbar fusion. Again seen are rods with screws entering the L4 and L5 vertebral bodies, appearing similar to prior. We see no radiographic evidence of hardware complication. Amorphous bone graft is noted along the lateral aspects of the lumbar spine. Moderate degenerative disk disease affects the L5/S1 level. Grade 1 anterolisthesis of L4 on L5 is present. Hyperlordosis is similar to prior. | Postoperative changes of lower lumbar spinal fusion, as described above. |
Generate impression based on findings. | Male 55 years old Reason: left shoulder pain History: above. We have 3 views of the right shoulder. There is a suture anchor within the greater tuberosity. A round defect in the proximal humerus may represent prior biceps tenodesis. Mild to moderate osteoarthritis affects the glenohumeral joint. Widening of the acromioclavicular joint is likely postoperative in etiology. There is mild irregularity of the surface of the greater tuberosity which we suspect is degenerative in etiology.We have 3 views of the left shoulder. There are two suture anchors within the greater tuberosity. Widening of the acromioclavicular joint is likely postoperative in etiology. There is mild osteoarthritis of the glenohumeral joint. | Postoperative changes and osteoarthritis of the glenohumeral joints as described above. |
Generate impression based on findings. | Lumbar effusion Again seen are fusion rods with screws entering the L4 and L5 vertebral bodies. An intervertebral disk spacer is noted at the L4/L5 level, with early bony bridging at the anterior aspect of the disk space. We see no radiographic evidence of hardware complication. There is mild grade 1 anterolisthesis of L4 on L5, which is stable on flexion, neutral, and extension views. We see no evidence of instability.Moderate degenerative disk disease affects the L3/L4 level. | Postoperative changes, without evidence of instability. |
Generate impression based on findings. | Esophageal cancer status post esophagectomy now with recurrence.RADIOPHARMACEUTICAL: 12.5 mCi F-18 fluorodeoxyglucose (FDG).BLOOD GLUCOSE (FASTING): 78 mg/dL. Today's CT portion grossly demonstrates partial opacification of the bilateral maxillary sinuses. The patient is status post esophagectomy with an intrathoracic gastric interposition which is fluid filled. There are small bilateral pleural effusions with overlying compressive atelectasis/consolidation. Patchy ground glass opacities are noted in the right middle lobe, left lingula, and left lower lobe. A right chest port catheter terminates in the SVC. There is a large amount of ascites. The right colon is distended and filled with amorphous stool. There is new moderate right hydronephrosis. A Foley catheter is noted. There is lower extremity and dependent subcutaneous edema. Today's PET examination demonstrates multiple new foci of hypermetabolic activity within the pelvis including a left acetabular lesion (max SUV = 9.3). There are new hypermetabolic foci in the C4, C7, T6, and L3 vertebral bodies. New FDG avid lesions are also noted in the right 3rd rib, the right clavicle, left proximal humerus, and right proximal femur. Several foci of hypermetabolic activity are also noted within the distal stomach at the level of the diaphragm which are also suspicious for metastatic disease. There is a hypermetabolic focus of activity within the right middle lobe (max SUV = 3.2) corresponding to a ground glass opacity which likely represents infection/inflammation. Additional mildly hypermetabolic foci are noted in the left lingula and left lung base which also likely represent infection/inflammation. | 1.Multiple new osseous metastatic lesions. Foci of hypermetabolic activity within the distal stomach are also highly suspicious for metastatic disease.2.Hypermetabolic activity within the right middle lobe, left lingula, and left lung base likely represents infection/inflammation.3.New moderate right hydronephrosis. |
Generate impression based on findings. | There is no evidence of intracranial hemorrhage, mass, or cerebral edema. There are unchanged patchy foci of low attenuation in the supratentorial periventricular and subcortical white matter. The ventricles and basal cisterns are unchanged. There is no hydrocephalus. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There are bilateral lens implants. The skull and extracranial soft tissues are unremarkable. | 1.No acute intracranial hemorrhage or skull fracture.2.Moderate chronic small vessel ischemic changes. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report. |
Generate impression based on findings. | 12 year old female with right lower quadrant abdominal pain and diarrhea. Colonoscopy with ulcers in the ICV, pathology was normal. Evaluate for Crohn's disease. EXAMINATION: MR enterography without and with IV contrast 2/24/2015 15:08 ABDOMEN:LIVER, BILIARY TRACT: Liver is normal with no evidence of intra-or extrahepatic biliary ductal dilatation. Gallbladder is normal. SPLEEN: Normal.PANCREAS: Normal with no evidence of pancreatic ductal dilatation.ADRENAL GLANDS: Normal.KIDNEYS, URETERS: Normal with no evidence of hydronephrosis.RETROPERITONEUM, LYMPH NODES: No free fluid or lymphadenopathy.BOWEL, MESENTERY: Normal caliber with no evidence of bowel wall thickening or obstruction.BONES, SOFT TISSUES: Normal.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: Normal.BLADDER: Normal. LYMPH NODES: No evidence of lymphadenopathy.BOWEL, MESENTERY: Normal caliber with no evidence of bowel wall thickening or obstruction.BONES, SOFT TISSUES: Normal.OTHER: No significant abnormality noted. | No evidence of Crohn's disease as clinically questioned. |
Generate impression based on findings. | 6-month-old male with lower extremity PICC placement.VIEW: Abdomen AP (one view) 2/24/2015 15:43 Feeding tube tip in stomach within the giant omphalocele. Left lower extremity PICC with tip in the left common iliac vein. Interval placement of right lower extremity PICC with tip coiled in the right external iliac vein. Cardiothymic silhouette cannot be evaluated. Minimal perihilar atelectasis not significantly changed. Left lung is obscured by the omphalocele. Multiple dilated loops are again seen within the omphalocele. | Right lower extremity PICC with tip coiled in the right external iliac vein. |
Generate impression based on findings. | Left total knee arthroplasty Two views of the left knee demonstrate hardware components of a left total knee arthroplasty device situated in near-anatomic alignment, without radiographic evidence of hardware complication. Anterior soft tissue gas, surgical drain, and skin staples reflect recent prior surgery. | Postoperative changes of a left total knee arthroplasty device as above. |
Generate impression based on findings. | Thumb pain Severe osteoarthritis affects the basilar joint. The remainder of the right hand is within normal limits. | Severe basilar joint osteoarthritis. |
Generate impression based on findings. | Male 67 years old; Reason: carpal instability s/p screw fixation 3 yr ago loose screw vs scaphoid fx History: new pain snuffbox Again seen is a screw affixing the scaphoid and lunate in near-anatomic alignment, though there is slight widening of the scapholunate interval on the grip view, which appears similar to the prior study. The head of the screw partially overlies the radiocarpal joint. Lucency around the screw may represent mild loosening, though appears similar to prior. No scaphoid fracture is seen. Mild osteoarthritis affects the radiocarpal and basilar joints. | Orthopedic fixation of the scapholunate interval as described above, with findings which may represent loosening of the screw. No scaphoid fracture is seen. |
Generate impression based on findings. | Male 69 years old; Reason: fracture History: fall Mild soft tissue swelling is present along the ulnar styloid. No underlying fracture is seen. Mild osteoarthritis affects the articulation of the scaphoid and trapezium. | Mild soft tissue swelling and osteoarthritis, without fracture evident |
Generate impression based on findings. | 13-year-old male with pain and swellingVIEWS: Right knee, AP, oblique, and lateral (3 views) 2/24/15 15:53 Alignment is anatomic. No fracture is evident. A joint effusion is not present. | Normal examination. |
Generate impression based on findings. | Female 51 years old Reason: eval for fracture; hx of fall History: R hip pain. Two views of the right hip show no fracture.AP view of the pelvis shows no fracture. The hip joints appear normal. Degenerative disk disease affects the lower lumbar spine. | No fracture evident. Degenerative disk disease of the lower lumbar spine. |
Generate impression based on findings. | Male, 25 years old, with deviated nasal septum, prior nasal fracture. Evaluate sinuses and nasal passages. The frontal sinuses and frontoethmoidal recesses are clear. Minimal patchy thickening/opacification is seen through the ethmoid air cells. The sphenoid sinuses and sphenoethmoidal recesses are clear. Maxillary sinuses are clear and the maxillary outflow pathways are unobstructed.Deformity of the nasal bones is seen compatible with history of prior fracture. The nasal septum is intact and deviates mildly towards the left where it contacts the left inferior turbinate. The turbinates themselves are unremarkable. The nasal cavity is clear. | 1.Deformity of the nasal bones compatible with history of prior fracture.2.Mild leftward deviation of the nasal septum.3.No significant sinus inflammatory disease. |
Generate impression based on findings. | Female 60 years old; Reason: please perform CT abdomen/ pelvis with and without contrast History: surveillance of hx of renal cell ca ABDOMEN:LUNG BASES: No significant abnormality noted.LIVER, BILIARY TRACT: No significant abnormality noted.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: Nodular bilateral adrenal glands, unchanged, favoring benign etiology like adenoma.KIDNEYS, URETERS: Redemonstrated multiple bilateral hypodense lesions, some of which are too small to accurately characterize. The larger lesions do not enhance, and are grossly unchanged from prior study, favoring benign cysts. Morphologic changes of the kidney, suggestive of acquired cystic disease.RETROPERITONEUM, LYMPH NODES: Mild/moderate plaque and calcification of the abdominal aorta and its branchesBOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: No significant abnormality noted. Small calcified uterine fibroids.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted. Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.No evidence of recurrence. Bilateral renal hypodense lesions are likely simple cysts, several of which are too small to accurately characterize. |
Generate impression based on findings. | The frontal sinuses are unformed. Mild opacification of the anterior ethmoid air cells. No significant opacification of the maxillary sinuses. Mild mucosal thickening of the posterior ethmoid air cells. The sphenoid sinuses are clear bilaterally. There is mild opacification at the right sphenoethmoidal recess. Mastoid air cells are clear bilaterally. There are no air-fluid levels. The bilateral maxillary sinus ostia are patent. The lamina papyracea are intact bilaterally. The floor of the anterior cranial fossa and cribriform plate region are unremarkable. The nasal septum is mildly deviated to the right. Bilateral orbits and the posterior nasopharynx appear unremarkable. | 1.Mild opacification of the anterior and posterior ethmoid sinuses.2.No evidence of significant acute or chronic sinusitis. |
Generate impression based on findings. | Female 67 years old Reason: eval for SBO History: recent SBO s/p small bowel resection, now with pain and vomiting again ABDOMEN:LUNG BASES: Interval resolution of small right pleural effusion. LIVER, BILIARY TRACT: Interval placement of percutaneous biliary drain. Pneumobilia which is likely iatrogenic in nature. Common bile duct stent in place. The portal vein, splenic vein, and mesenteric vein are patent. Status post cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: Hypoattenuating peri-ampullary/pancreatic head mass again identified measuring approximately 1.5 x 2.5 cm (series 4, image 48), previously 1.7 x 2.6 cm. Persistent pancreatic parenchymal atrophy and pancreatic ductal dilatation, unchanged.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant small bowel dilatation. No evidence of obstruction. No intraperitoneal free air or pneumatosis. Duodenal stent in place extending from the gastric antrum to the third part of the duodenum. Debris is noted within the stent likely enteric contents. BONES, SOFT TISSUES: Postsurgical changes in the midline anterior wall.OTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical changes from prior small bowel resection. Colonic diverticula without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.No evidence of small bowel obstruction.2.Interval resolution of small right pleural effusion.3.Resolution of intrahepatic biliary ductal dilatation status post percutaneous biliary drain.4.Stable peripancreatic/pancreatic head mass with pancreatic atrophy and pancreatic ductal dilatation. |
Generate impression based on findings. | The internal auditory canals are symmetrical and normal in size and signal intensity. The inner ears are normal, with normal T2 signal and no pathological enhancement. No abnormal mass or abnormal enhancement is seen within the cerebellopontine angle, cisterns bilaterally or within the internal auditory canals. No abnormal or asymmetric enhancement is noted along the expected course of the facial nerves along the skull base.The ventricles and sulci are within normal limits for age. The cisterns remain patent. There is no midline shift or mass effect. There are scattered foci of T2/FLAIR hyperintensity within the subcortical and deep white matter, likely representing mild chronic small vessel ischemic changes. There are no areas of pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is opacification of a posterior left ethmoid air cell | 1. No acute infarct. Mild chronic small vessel ischemic changes.2. No MR abnormality within the IACs or involving the facial nerves bilaterally. |
Generate impression based on findings. | Clinical information PULMONARY ARTERIES: Large filling defect in the right main pulmonary artery, extending into the lobar and segmental branches throughout the right lung. The main pulmonary artery is normal in caliber. No evidence of right heart strain.LUNGS AND PLEURA: Wedge-shaped area of groundglass and consolidation in the right upper lobe, compatible with an infarct and associated hemorrhage. Atelectasis involving the lateral segment of the middle lobe.Small right pleural effusion with associated right lower lobe atelectasis.Mild compressive atelectasis at the left lung base associated with a hiatal hernia. Otherwise, the left lung is clear.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. No visible coronary artery calcifications.Patulous, fluid-filled esophagus, and a large hernia.No mediastinal or hilar lymphadenopathy.CHEST WALL: Degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. No significant abnormality noted. | Large pulmonary embolus in the right main pulmonary artery, extending into the lobar and segmental branches, with associated right upper lobe infarct and hemorrhage, as well as atelectasis/consolidation involving the middle and right lower lobes. Small pleural effusion.PULMONARY EMBOLISM: PE: Positive.Chronicity: Acute.Multiplicity: Multiple.Most Proximal: Main.RV Strain: Negative. Findings discussed with Dr Wolfson in the ED via telephone at 4:30 PM. |
Generate impression based on findings. | PICC placement. Neuroblastoma.VIEW: Chest AP (one view) 02/24/15, 1613 Right central line tip is in right atrium. Left upper extremity PICC tip is at junction of brachiocephalic veins. Surgical clips are seen in the left upper quadrant.Cardiothymic silhouette is normal. No focal lung opacity is present. A pleural effusion is not present. | Left upper extremity PICC tip at junction of brachiocephalic veins. |
Generate impression based on findings. | 28 years, Male, Reason: 28 y/o male with history of Crohn's disease with ileal stricture, entero-enteric fistula, recurrent SBO History: bloating, constipation. ABDOMEN:LIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: There is mild mucosal hyperenhancement and narrowing involving the distal and terminal ileum suggesting mild active inflammation. A short stricture between adjacent ileal loops is unchanged (6/21). A noninflamed Meckel's diverticulum is incidentally noted adjacent to the strictured segment. No new fistulas are identified. No abscesses are evident.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: MalePROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Mild active inflammation of the distal and terminal ileum in a similar distribution to the prior exam.2.Small stricture in the distal ileum is unchanged from the prior exam. |
Generate impression based on findings. | Male 52 years old; Reason: Evaluate for malignancy History: lumbar polyradiculopathy CHEST:LUNGS AND PLEURA: No significant abnormality noted.MEDIASTINUM AND HILA: Small prevascular and paratracheal lymph nodes measuring up to 8 mm in maximum short axis dimension. Additional calcified mediastinal and hilar lymph nodes seen and right lower lobe pulmonary coarse calcifications, likely reflecting sequela of prior granulomatous disease.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Hepatic and splenic calcified granulomata, likely related to prior granulomatous disease.SPLEEN: Subcentimeter splenule. Hepatic and splenic calcified granulomata, likely related to prior granulomatous disease.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: Subcentimeter retroperitoneal and portacaval lymph nodes.BOWEL, MESENTERY: Small hiatal hernia.PELVIS:PROSTATE, SEMINAL VESICLES: Hypertrophy of median lobe of prostate. Incompletely imaged small extratesticular fluid seen bilaterally, may be small hydroceles.BLADDER: Collapsed bladder, making assessment for underlying wall thickening suboptimal.BONES, SOFT TISSUES: Mild multilevel degenerative changes of spine. | Sequela of prior granulomatous disease, unremarkable exam otherwise. |
Generate impression based on findings. | Female, 35 years old, with chronic sinusitis, worsening PND, cough and asthma. The frontal sinuses are small but the sinuses and the sinus recesses are unobstructed. The sphenoid sinuses and sphenoethmoidal recesses are clear and obstructed. The ethmoid air cells are clear.Maxillary sinuses are free of significant mucosal thickening and accumulated secretions. The maxillary outflow pathways are unobstructed.The nasal septum is intact but deviates toward the left with a leftward projecting bony spur which almost contacts the root of the left inferior turbinate. The turbinates themselves are unremarkable with conchae bullosae of the middle turbinates. The nasal cavity is clear. | No evidence of significant sinus inflammatory disease. |
Generate impression based on findings. | Squamous cell cancer of tongue and new dx prostate CA eval bone mets. Abnormal increased cavity is visualized throughout the cervical, thoracic and lumbar spine, in particular within the mid-cervical, T4-T6 and T10-L2 levels. Increased activity suspicious for metastases are also noted within the right acetabulum and ribs bilaterally. Two questionable focal areas of uptake are noted adjacent to the bilateral SI joints. | Abnormal activity correlating with likely osseous metastases within the spine, ribs, and right acetabulum. Questionable osseous activity is noted adjacent to the bilateral SI joints. |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.