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Generate impression based on findings. | Male 52 years old; Reason: renal tx hematoma/mass History: hematuria ABDOMEN:LUNGS BASES: No significant abnormality noted.LIVER, BILIARY TRACT: Hepatic and splenic calcified granulomata, likely reflecting prior granulomatous disease.SPLEEN: Stable in size.PANCREAS: Prominent pancreas stable in size, nonspecific, correlation with patient's clinical history and laboratory values recommended to exclude underlying pancreatitis. ADRENAL GLANDS: Thickened appearance, unchanged.KIDNEYS, URETERS: Right iliac fossa transplant kidney with unchanged marked hydronephrosis. Again seen is lobulated high density material in the urinary collecting system, demonstrating postcontrast enhancement, as evidenced by the change in Hounsfield units greater than 20 on postcontrast imaging compared to precontrast imaging. Enhancing soft tissue attenuation seen along course of ureter and extends to level of ureterovesical junction. Multiple subcentimeter simple cystic foci seen in transplanted kidney, several too small to characterize/larger ones measuring simple fluid, image 102 series 80468. Atrophic native kidneys with innumerable renal hypoattenuating lesions, majority of which are too small to characterize, largest lesions measure simple fluid. RETROPERITONEUM, LYMPH NODES: Aortobiiliac atherosclerotic disease.BOWEL, MESENTERY: Large stool in colon without evidence of bowel obstruction. Unchanged mild diffuse mesenteric edema.PELVIS:PROSTATE/SEMINAL VESICLES: Prostate measures up to 4.2 cm in transverse dimension.BLADDER: Underdistended bladder, making assessment for wall thickening suboptimal, mild underlying wall thickening and minimal mucosal enhancement not entirely excluded.BONES, SOFT TISSUES, OTHER: Visualized osseous structures stable in appearance. Stable small abdominopelvic simple ascites. Asymmetry with respect to size of rectus abdominus muscles with the left side larger and more hyperattenuating in appearance, appearance may reflect may reflect fatty atrophy of right side rectus muscle and/or left rectus sheath hematoma, appear stable from prior study. | 1. Findings suspicious for urothelial malignancy. Again visualized is high attenuation material in collecting system of transplanted right iliac fossa kidney, extending to ureterovesical junction, associated enhancement seen.2. Remainder of exam also without significant change as described. |
Generate impression based on findings. | A 66 year old male candidate for mitral valve repair because of significant regurgitation. 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 mildly tortuous. No protruding aortic atheroma or thrombus is noted in the thoracic aorta. There is no calcification of the aortic root. There is mild calcification of the aortic arch. There is no calcification of the descending aorta. No aortic coarctation is noted. There is non significant atherosclerosis of the proximal brachiocephalic vessels, mild calcification of the left subclavian. Aortic Valve: The aortic valve is trileaflet. There is mild aortic valve calcification, which predominantly involves the non-coronary cusp. Mitral Valve: No mitral annular calcification is noted.Left Ventricle: The left ventricular late diastolic volume is mildly increased (LV volume 212ml). There is no thrombus noted in the left ventricle. The morphology of the interventricular septum is within normal limits. Right Ventricle: Visually the right ventricular late diastolic volume is mildly increased.Left Atrium: The left atrium is moderately dilated. There are four distinct pulmonary veins which drain normally into the left atrium. There is no evidence of left atrial appendage thrombus.Right atrium, vena cavae, and coronary sinus: The right atrium is normal in size. The superior and inferior vena cavae are grossly normal. The coronary sinus is normal in size. Pulmonary Artery: Normal in size.Pericardium: The pericardium is normal in thickness. There is no pericardial effusion.Coronary arteries: Because heart rate management was not attempted and nitroglycerin was not administered, this exam was not performed to optimally visualize the coronary arteries. However within the limitations of the study the following observations are made:LM: The left main coronary artery arises normally from the left sinus of Valsalva and bifurcates into the left anterior descending and left circumflex coronary arteries. There is mild calcification of the left main coronary artery. LAD: The left anterior descending coronary artery courses normally in the anterior interventricular groove, supplying the diagonal and septal branches. There is moderate calcification of the proximal LAD. LCx: The left circumflex coronary artery courses normally in the left AV groove. It gives rise to the obtuse marginal branches and a small AV circumflex branch. There is mild calcification of the LCx.RCA: The right coronary artery arises normally from the right sinus of Valsalva. It is a co-dominant coronary artery together with the LCx supplying a posterior descending artery and a posterolateral branch. There is mild calcification of the RCA. Coronary Bypass Grafts:None present. | 1. There is mild aortic valve calcification, which predominantly involves the non-coronary cusp. 2. No mitral annular calcification is noted.3. Mild left ventricular and moderate left atrial dilatation.4. Mild global degree of coronary artery calcification.5. Normal thoracic aorta anatomy.This portion of the report pertains to the heart and great vessels only. The remaining soft tissues of the thorax and upper abdomen will be interpreted by the attending chest radiologist and included as an addendum to this report. The abdomen/ pelvis CTA will be reported separately. |
Generate impression based on findings. | Postoperative changes are seen from left occipital craniotomy and gross total resection of a left cerebellar tumor. A slightly irregular resection cavity is present within the left cerebellum containing CSF signal intensity fluid. Mild scattered marginal areas of diffusion restriction with associated susceptibility extending minimally into the vermis, correlating with postoperative blood products, although the possibility of underlying marginal ischemia cannot be excluded. The left cerebellar tonsil continues to herniate below the level of the foramen magnum. Evaluation for residual mass is difficult and would be better delineated with 3-D T2 FLAIR images on the follow-up exam, which better delineates the margins of the mass.Scattered foci of susceptibility are seen scattered intracranially and extra axial space, most confluent along the left frontal lobe, consistent with pneumocephalus. Susceptibility is also seen in the occipital horns dependently which may relate to blood products. Minimal rounded susceptibility is also present in the third ventricle.There is decreased effacement and mass effect on the fourth ventricle. The ventricles and sulci are otherwise stable, with mild nonspecific prominence the lateral and third ventricles. The cisterns remain patent. There is no midline shift. There are no areas of pathological enhancement. Minimal linear T2/FLAIR hyperintensity is seen just above the midbody of the lateral ventricles, with extension through the right frontal lobe likely relating to a previous tract via right frontal burr hole. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. There is abnormal up to 12-mm extension of the left greater than right cerebellar tonsils below the level of the foramen magnum, likely relating to an acquired Chiari malformation. There is associated significant crowding at this level, although the cerebellar tonsil contour remains rounded. The midline structures and craniocervical junction are otherwise within normal limits. | 1. Partial resection of left cerebellar mass with expected postoperative findings, with decreased mass effect upon and effacement of the fourth ventricle. Evaluation for residual mass is difficult. This would be better assessed utilizing 3-D T2 FLAIR images on follow-up imaging once immediate postoperative is resolved, with better delineation of margins of the mass.2. Slight decreased extent of crowding at the level of the foramen magnum due to the tumor decompression, although with residual acquired Chiari malformation. |
Generate impression based on findings. | Male, 62 years old, altered mental status. Extensive periventricular hypoattenuation is seen along with additional scattered more focal lucencies in the periventricular regions as well as the left thalamus/internal capsule. Chronic infarctions of the left cerebellum and left occipital lobe are seen.No definite parenchymal edema, mass effect or loss of gray-white distinction is detected. No intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricular size and morphology are within normal limits.The osseous structures of the skull are intact. The paranasal sinuses and mastoid air cells are clear. | Evidence of old cortical and age indeterminate microvascular ischemic disease. Although no CT evidence of acute territorial ischemia is evident on this examination, if clinical concern persists, further imaging with MRI would be appropriate. |
Generate impression based on findings. | Female 69 years old; Reason: evaluate for cancer recurrence and hernia History: ovarian cancer - normal exam but increased abdominal symptoms and hernia on exam ABDOMEN:LUNG BASES: Reticular opacities, likely atelectasis or scarring and some areas of architectural distortion involving the right middle lobe and lingula.LIVER, BILIARY TRACT: Status post cholecystectomy.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: Calcific changes in the aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:UTERUS, ADNEXA: AbsentBLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: Ventral hernia containing a loop of transverse colon without evidence of strangulation or herniation.Minimal compressive changes of the superior aspect of L5 vertebral body.OTHER: No significant abnormality noted. | 1.No definite evidence of recurrence. Ventral hernia as described above. |
Generate impression based on findings. | Female 59 years old; Reason: 59 y/o female with metastatic CRC; receiving chemotherapy; new onset abdominal pain History: Abdominal pain CHEST:LUNGS AND PLEURA: Multiple bilateral pulmonary masses, the largest of which contain gaseous foci, likely reflecting underlying cavitation. Reference left lower lobe lesion stable to mildly decreased in size, measuring 5.1 x 3 .4 cm, image 54 series 5, previously measured 5.2 x 3.6 cm.MEDIASTINUM AND HILA: Right chest wall port with tip in mid to distal SVC. Multiple mediastinal and hilar calcifications as well splenic calcifications, likely reflecting sequela of prior granulomatous disease.CHEST WALL: No significant abnormality noted.ABDOMEN:LIVER, BILIARY TRACT: Cholelithiasis.SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: Symmetric renal parenchymal enhancement.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Extensive submucosal fat deposition in right colon, sequela of chronic inflammation. Right-sided ostomy. Low lying rectum, may reflect component of rectal prolapse.PELVIS:UTERUS, ADNEXA: No significant abnormality noted.BLADDER: No significant abnormality noted.BONES, SOFT TISSUES: Visualized osseous structures to appearance. Spinal degenerative disease. Again seen is proximal right femoral lytic lesion similar to prior study. | Stable to mild interval decrease in size of pulmonary metastatic lesions, which internal cavitation seen.Remainder of exam unchanged. |
Generate impression based on findings. | Female 27 years old Reason: Evaluate LLQ pain; possible renal stone; but concern for GI process as well; previously thought do to hemorrhagic ovarian cyst, but cyst resolved on U/S and pain remains History: LLQ shooting pains and more severe pain in back and abdomen radiating into groin and leg ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: No significant abnormality notedSPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | Unremarkable study. |
Generate impression based on findings. | Female 81 years old Reason: r/o fx History: pain after fall. Three views of the right wrist show soft tissue swelling. There is chondrocalcinosis of the wrist. There is severe osteoarthritis of the basilar joint and the trapezioscaphoid articulation. We see no fracture.Two views of the right forearm show the aforementioned wrist findings. We see no fracture. The radius and ulna appear normal. | Osteoarthritis and chondrocalcinosis of the wrist. We see no fracture. |
Generate impression based on findings. | Male 44 years old Reason: advanced pancreatic cancer. asses for need of duodenal stent History: worsening abd distention and ascites CHEST:LUNGS AND PLEURA: Left lower lobe atelectasis. Stable micronodules.MEDIASTINUM AND HILA: No significant abnormality notedCHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Again noted mild pneumobilia metallic stents in the common bile duct. Mild biliary prominence in the left hepatic lobe persists. Enhancement of the liver is suboptimal for evaluation of focal liver lesions.SPLEEN: No significant abnormality notedPANCREAS: Patient's known mass in the pancreatic head now measures 2.2 by 2.1 cm on image number 54, series number 80376, slightly enlarged compared to previous study. Upstream pancreatic ductal dilatation is again noted. Patient's known pancreatic mass invades the main portal vein, unchanged. The mass also encases the celiac axis, proximal SMA.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Right kidney is not visualized. Left kidney is unremarkable.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Generalized anasarca. Moderate amount of ascites. Wall thickening of the entire bowel segments, likely secondary to portal vein occlusion. Interval development of moderate amount of ascites and interval worsening of the small bowel wall thickening.BONES, SOFT TISSUES: Generalized anasarca.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Please see discussion aboveBONES, SOFT TISSUES: Generalized anasarca.OTHER: No significant abnormality noted | Interval increase in the size of the patient's known pancreatic head cancer. Interval development of moderate amount of ascites and interval worsening of the small bowel wall thickening. |
Generate impression based on findings. | Female 65 years old Reason: right wrist pain History: as above. There is widening of the scapholunate interval to approximately 6 mm indicating ligament disruption with severe narrowing of the radioscaphoid articulation. There is also mild osteoarthritis of the basilar joint and trapezioscaphoid articulation. There is slight dorsal tilt of the lunate. There is chondrocalcinosis in the ulnar aspect of the wrist. | Arthritic changes as described above suggest a combination of CPPD arthropathy and osteoarthritis with scapholunate ligament disruption. |
Generate impression based on findings. | Male 58 years old Reason: concern for compartment syndrome History: swelling, elevated CK. Mild osteoarthritis affects the hip. There may be mild soft tissue swelling, but we see no acute abnormalities. | Osteoarthritis of the hip. Please note, we cannot confirm or exclude compartment syndrome on the basis of radiographs. |
Generate impression based on findings. | Female 64 years old Reason: OA and osteoporosis hx. LBP w/ neuropathic symptoms. ? DDD vs. compression fx vs. other History: see above. Moderate facet joint osteoarthritis affects the lower lumbar spine with relatively mild facet joint osteoarthritis affecting the upper lumbar spine. There is mild degenerative disk disease at L3/L4 and perhaps L4/L5. The lumbar vertebral body heights are maintained and alignment is within normal limits.Severe degenerative disk disease affects T11/T12. | Facet joint osteoarthritis and degenerative disk disease. We see no compression fracture. |
Generate impression based on findings. | Male 63 years old Reason: swelling History: knee swelling. Mild to moderate osteoarthritis affects the knee and this appears to have progressed when compared to the prior study. A small density adjacent to the medial epicondyle of the distal femur is unchanged and may reflect prior injury. There may be a small joint effusion, but this is equivocal.Mild osteoarthritis affects the right knee as seen on the frontal view. | Progression of osteoarthritis. Other findings as above. |
Generate impression based on findings. | Female 34 years old Reason: rule out arthritic changes History: pain. Mild osteoarthritis affects the left knee and has progressed when compared to the prior study.Mild osteoarthritis also affect the right knee as seen on the frontal view. | Mild osteoarthritis. |
Generate impression based on findings. | Male 55 years old Reason: s/p head and neck reconstruction, please evaluate position of plate and bone History: s/p head and neck reconstruction. We have a Panorex radiograph of the mandible. A plate and screw device affixes bone graft to the underlying maxilla in gross anatomic alignment. We see no hardware complications. A bony excrescence projects inferiorly from the left side of the maxilla, superficial to the left mandibular body. There is a defect along the alveolar ridge of the left mandibular body with a thin sclerotic margin that is nonspecific but we suspect benign in etiology.There multiple dental fillings and surgical clips in the soft tissues. | Postoperative changes of bone graft fixation to the maxilla as described above. |
Generate impression based on findings. | Male 25 years old Reason: shoulder pain, evaluate for dislocation History: pain and decreased ROM. There is a minimally displaced fracture through the greater tuberosity associated with a lipohemarthrosis. There is slight inferior "pseudosubluxation" of the humeral head, but we see no frank dislocation. | Greater tuberosity fracture.These findings were verbally relayed to Maricela Sandoval, APN on 2/24/2015 at 1747. |
Generate impression based on findings. | Male 45 years old; Reason: r/o fx History: bilateral rib pain from 5 down after MVA approx 2 months ago, getting worse We see no fracture or other specific findings to account for the patient's rib pain. | No rib fracture evident. |
Generate impression based on findings. | Pain. Fracture? The bones are demineralized suggesting osteopenia/osteoporosis. I see no fracture. Mild osteoarthritis affects the glenohumeral and acromioclavicular joints. There is spurring of the anterior acromial process. There is narrowing of the acromiohumeral interval which may reflect chronic rotator cuff tear or atrophy. | Degenerative arthritic changes of the shoulder as described above without acute fracture evident. |
Generate impression based on findings. | 32 year-old female with right lateral ankle pain status post injury last night. Evaluate for fracture. Rounded opacity anterior to the tibiotalar joint suggests a joint effusion, but I see no fracture or malalignment of the ankle. There is mild soft tissue swelling along the lateral aspect of the ankle. | Soft tissue swelling and tibiotalar joint effusion without fracture evident. |
Generate impression based on findings. | MCP pain. Evaluate for fracture. Seen only on the oblique views a punctate density along the dorsal and radial aspect of the first metacarpal head. The clinical significance of this finding is uncertain although the possibility of a tiny avulsion fracture fragment is considered. I see no fracture line, and alignment of the first MCP joint is within normal limits. | Punctate density adjacent to the first metacarpal head is of uncertain significance, although the possibility of a tiny avulsion fracture fragment is considered. |
Generate impression based on findings. | Left foot pain for one week after starting exercise program There is a mild hallux valgus deformity. Alignment is otherwise within normal limits. I see no fracture. The bones appear slightly demineralized. | Mild hallux valgus deformity but otherwise no specific findings to account for the patient's pain. If there is clinical concern for stress fracture, repeat radiographs may be obtained in 7 to 14 days. |
Generate impression based on findings. | Ulcer right index finger. Evaluate for "osteo" distal and middle phalanx. Evaluation of the fingers is limited due to inability to place the hand flat on the cassette. There is loss of soft tissue along the tip of the index finger, with osteolysis of the underlying distal phalanx compatible with osteomyelitis. I see no specific findings to suggest osteomyelitis of the middle phalanx. The tuft of the distal phalanx of the ring finger is poorly defined which may represent an additional site of osteomyelitis. The distal phalanges of the middle finger and thumb are foreshortened, but appear corticated, perhaps reflecting prior infection, but I see no osteolysis to confirm active osteomyelitis of these bones. Tiny bone fragments are seen within the soft tissues distal to the distal phalanx of the thumb. There is swelling of the soft tissues of the middle finger. There is congenital coalition of the lunate and triquetrum, a normal variant, with slight widening of the scapholunate interval. | Findings suggestive of osteomyelitis of the distal phalanx of index finger, and possibly of the distal phalanx of the ring finger. Other abnormalities as described above. |
Generate impression based on findings. | The right anterior division of the internal iliac artery was embolized using a gelfoam slurry until near stasis was achieved. The post-embolization angiogram confirmed these findings.LEFT UTERINE ARTERY EMBOLIZATION | 1. Successful embolization of the anterior division of the internal iliac artery bilaterally.2. Placement of right internal jugular triple lumen temporary venous catheter.PLAN: Discharge from procedure area in good condition, temporary line ok to use. |
Generate impression based on findings. | Hip pain radiating to the knee. Osteoarthritis? Two views of the right hip are provided. Severe osteoarthritis affects the right hip with bone-on-bone apposition superiorly. The bones are demineralized suggesting osteopenia/osteoporosis. Severe degenerative disk disease affects the visualized lower lumbar spine.Four nonweightbearing views of the right knee are provided. The bones appear demineralized suggesting osteopenia. The knee otherwise appears normal for age. | Severe osteoarthritis of the hip. |
Generate impression based on findings. | Inflammatory arthritis? Hypertrophic arthropathy? Osteoarthritis? History of lymphoma. Three views of the right hand are provided. Mild to moderate osteoarthritis affects the distal interphalangeal joint of the fifth finger. The hand otherwise appears normal with no specific radiographic features of inflammatory arthritis or hypertrophic osteoarthropathy.Three views of the left hand are provided. Mild osteoarthritis affects the DIP joint of the fifth finger. The hand otherwise appears normal with no specific radiographic features of inflammatory arthritis or hypertrophic osteoarthropathy.Three views of the right foot are provided. Minimal osteoarthritic changes affect the forefoot, midfoot, and ankle. I see no specific radiographic features of inflammatory arthritis or hypertrophic osteoarthropathy. An ossicle posterior to the talus likely represents a normal variant os trigonum.Three views of the left foot are provided. Minimal osteoarthritic changes affect the forefoot and midfoot. I see no specific radiographic features of inflammatory arthritis or hypertrophic osteoarthropathy. An ossicle posterior to the talus likely represents a normal variant os trigonum. | Degenerative arthritic changes as described above, overall mild. I see no specific radiographic features of inflammatory arthritis or hypertrophic osteoarthropathy. |
Generate impression based on findings. | 55 years, Female, Reason: mets lung cancer. s/p 2 cycles of ABT-7-- + Docetaxel. Pls c/w previous study and evaluate tx response. History: lung ca. ABDOMEN:LUNG BASES: For findings in the lung, please see dedicated chest CT performed on the same day.LIVER, BILIARY TRACT: Right hepatic hypodensity is too small to characterize. Hypoattenuating segment IVb lesion is stable measuring 2.1 x 1.5 cm (8/48), previously 2.4 x 1.4 cm. No new enhancing lesions are present. Mildly enlarged liver.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS: FemaleUTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Mild degenerative changes in lower lumbar spine. Sclerotic lesion in the left femoral head and neck. Small sclerotic foci in the right acetabulumOTHER: No significant abnormality noted | 1.Focal hypoattenuating hepatic lesion has a nonspecific appearance and while stable, a metastases cannot be excluded. Recommend dedicated liver MRI for further evaluation if clinically warranted.2.Sclerotic lesion in the left femoral head and neck is suspicious for a metastases. Sclerotic focus in the right acetabulum is nonspecific. |
Generate impression based on findings. | altered mental status There is no evidence of acute ischemic or hemorrhagic lesion.A small calcific density on the dural surface of right parahippocampal gyrus posterior aspect is seen without evidence of surrounding mass like density or edema indicating benign nature, comparing to prior scan, it appears to be a bit larger. The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | There is no evidence of acute ischemic or hemorrhagic lesion.Increase in size of the calcific density on the dural surface of right parahippocampal gyrus since prior study in 2004. If clinically indicated, brain MRI can be considered. |
Generate impression based on findings. | altered mental status No evidence of acute ischemic or hemorrhagic lesion.Moderate non specific small vessel ischemic disease with moderate diffuse brain atrophy which are age appropriate.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion.Non specific small vessel ischemic disease. |
Generate impression based on findings. | Fall down stairs No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion. |
Generate impression based on findings. | syncope, evaluation for possible cerebrovascular accident No evidence of acute ischemic or hemorrhagic lesion.There are patchy bihemispheric low attenuations on periventricular white matter and centrum semiovale, indicating non specific small vessel ischemic disease.The ventricles, sulci, and cisterns are symmetric and unremarkable. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion.Small vessel ischemic disease. |
Generate impression based on findings. | worst headache of life No evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci, and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass effect, edema, midline shift, intra- or extra-axial fluid collection/acute hemorrhage. The osseous structures are unremarkable. The paranasal sinuses and mastoid air cells are clear. | No evidence of acute ischemic or hemorrhagic lesion. |
Generate impression based on findings. | Clinical question:CVA signs and symptoms: CVA Nonenhanced head CTthere is no detectable acute intracranial process. CT however he is insensitive for early detection of acute nonhemorrhagic ischemic strokes.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation is within normal.There is mild prominence of cerebellar and vermian folia for age. Correlate with history.Unremarkable calvarial, scalp, orbits, paranasal sinuses and mastoid air cells. | No acute intracranial process. Please see above comments. |
Generate impression based on findings. | Clinical question: AMS and hypoxia, now intubated,? ICH in setting of thrombocytopenia. Signs and symptoms: As above. Nonenhanced head CT:There is no evidence of acute intracranial process. CT however is been sensitive for early detection of acute nonhemorrhagic ischemic strokes.The cerebral cortex, cortical sulci, ventricular system, CSF and spaces and gray -- white matter differentiation is beginning on.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells. | No acute intracranial process. |
Generate impression based on findings. | Clinical question: Rule out ischemia, hemorrhage. Signs and symptoms headache. Unenhanced head CT:There is no acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.There is very extensive periventricular and subcortical low attenuation of white matter with resultant prominence of cortical sulci.There is enlargement of shunted supratentorial ventricular system since prior study. The position of right frontal approach ventricular catheter with the tip in the left frontal horn however has not changed. Mild vascular calcification is noted.Unremarkable orbits, paranasal sinuses and mastoid air cells. | 1.No acute intracranial process. Please see above comments.2.Interval increased size of supratentorial ventricular system with no change in the position of right frontal approach ventricular catheter. |
Generate impression based on findings. | Clinical question: Headache worse rule out intracranial bleed or fracture. Signs and symptoms: Headache. Nonenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of accurate nonhemorrhagic ischemic strokes.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter differentiation is within normal for patient's stated age of 4 years.Calvarium is intact and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits. Extensive patchy opacification of all visualized paranasal sinuses and consistent with sinusitis. There is also bilateral opacification of mastoid air cells and middle ear cavities consistent with otitis media. | 1.Unremarkable nonenhanced head CT.2.Extensive pansinusitis.3.Bilateral otitis media. |
Generate impression based on findings. | 75 years, Female, Reason: abscess History: epigastric pain. ABDOMEN:LUNG BASES: Basilar atelectasis. Severe coronary artery calcifications.LIVER, BILIARY TRACT: Large gallstone with adjacent fat stranding, suspicious for acute cholecystitis. There is adjacent colon in this region, however no significant wall thickening or diverticula are observed.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Severe atherosclerotic calcifications of the aorta and its branches.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No ascites or pneumoperitoneum.PELVIS: FemaleUTERUS, ADNEXA: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Severe degenerative changes of the lower lumbar spine with anterior wedging of L1 which is unchanged from the prior exam. Severe osteoarthritic changes of the right hip.OTHER: No significant abnormality noted | Cholelithiasis with pericholecystic inflammatory changes is suggestive of acute cholecystitis, with a focal colitis considered less likely. |
Generate impression based on findings. | Rule out fracture I see no fracture. Mild osteoarthritis affects the acromioclavicular joint. Note is again made of metastatic disease to the left third rib from the patient's known prostate cancer. | No fracture evident. Osteoarthritis and metastatic disease as described above. |
Generate impression based on findings. | Clinical question: 69-year-old male with history of mechanical fall, on anti-coagulation, and without hemorrhage. Signs and symptoms : As above. Unenhanced head CT:There is no detectable acute intracranial process. CT however is insensitive for early detection of acute nonhemorrhagic ischemic strokes.The cerebral cortex, cortical sulci, ventricular system, CSF spaces and gray -- white matter initiation is within normal for stated age of 69. Unremarkable calvarium, soft tissues of the scalp, orbits, paranasal sinuses and mastoid air cells. | Negative nonenhanced head CT. |
Generate impression based on findings. | Female 57 years old Reason: pelvic mass, e/o met dx? History: pelvic mass, bloating, pain CHEST:LUNGS AND PLEURA: Moderate left pleural effusion. Small right upper lobe tree in bud opacity which may represent infection, please correlate clinically. No suspicious pulmonary masses or nodules.MEDIASTINUM AND HILA: Heart size is normal without pericardial effusion. No coronary artery calcifications. CHEST WALL: Small cardiophrenic and diaphragmatic lymph nodes are noted, but not enlarged.ABDOMEN:LIVER, BILIARY TRACT: No biliary ductal dilatation or focal hepatic mass. SPLEEN: No significant abnormality noted.PANCREAS: No significant abnormality noted.ADRENAL GLANDS: No significant abnormality noted.KIDNEYS, URETERS: No significant abnormality noted.RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No evidence of obstruction. No intraperitoneal free air or pneumatosis.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: Moderate abdominopelvic ascites with carcinomatosis. There is little solid components in the distribution of the omentum. The single solid region of carcinomatosis involvement in the left upper quadrant measures 2.5 x 1.7 cm (series 3, image 106). No other solid component is visualized.PELVIS:UTERUS, ADNEXA: Nonspecific, complex left adnexal focus measuring 5.0 x 3.4 cm (series 3, image 152) which is suspicious for malignancy.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted. | 1.Moderate ascites with carcinomatosis as above.2.Probable left adnexal mass which is suspicious for malignancy. Further characterization with pelvic ultrasound is recommended.3.Moderate left pleural effusion. |
Generate impression based on findings. | Fall off scaffolding, evaluate for bleed Head: No intracranial hemorrhage is identified. No intracranial mass or evidence of mass-effect. No midline shift or uncal herniation. Gray-white differentiation is maintained. No extra-axial collections. Ventricles are within normal limits without evidence of hydrocephalus.There is opacification of the left posterior ethmoid air cells. The visualized portions of the paranasal sinuses are otherwise clear. Mastoid air cells are clear. Calvarium is intact.Cervical Spine: No fracture or subluxation is seen within the cervical spine. The cervical vertebral bodies are appropriate height. Alignment is maintained. There is straightening of the cervical spine which may be positional. No suspicious bony lesions are identified in the cervical spine.Mild degenerative changes are seen including mild left neural foraminal stenosis at C2-C3 related to uncovertebral hypertrophy. Otherwise, no significant spinal canal or neural foramina stenosis is appreciated.Bilateral thyroid lobe nodules noted. Prevertebral and paraspinous soft tissues are unremarkable. Mild emphysematous changes are noted in the lungs.Thoracic Spine: There is no acute fracture or subluxation within the thoracic spine. Vertebral body heights in the thoracic spine are normal. Alignment is normal. There is no significant spinal canal or neural foramina stenosis at any level. There is facet arthropathy at the left T11-T12 level with hypertrophy and mild fragmentation which is likely chronic.There is a 1 cm nodule involving the right upper lobe as well as a 1 cm nodule involving the right lower lobe (series 4, axial thoracic images 52 and 72 of 111). There are calcifications involving mediastinal lymph nodes compatible with chronic granulomatous disease. | 1. No evidence of acute intracranial hemorrhage or mass effect. 2. No fracture or subluxation within the cervical spine.3. No fracture or subluxation within the thoracic spine.4. There is facet arthropathy at the left T11-T12 level with fragmentation which is most likely chronic.5. Two 1 cm right lung nodules. Recommend dedicated CT chest for further evaluation. |
Generate impression based on findings. | 85 years, Female, Reason: 85 y/o F with colitis, and PNA, eval PNA for abscess vs effusion, vs interval change of colitis vs SBO History: SOB, abdominal pain,. CHEST:LUNGS AND PLEURA: Small bilateral pleural effusions, right greater than left. Left basilar atelectasis and right basilar atelectasis/consolidation.MEDIASTINUM AND HILA: Thyroid nodule is unchanged. Severe atherosclerotic calcifications of the aorta and its branches. Severe coronary calcifications.CHEST WALL: No significant abnormality notedABDOMEN:LIVER, BILIARY TRACT: Cholecystectomy clips. Mild intrahepatic biliary ductal dilatation is decreased. Mild perihepatic ascites is decreased. Cirrhotic liver morphology.SPLEEN: Absent spleen.PANCREAS: Atrophic pancreas.ADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Poorly enhancing kidneys with renal cysts and scarring are unchanged.RETROPERITONEUM, LYMPH NODES: Severe atherosclerotic calcifications of the aorta and its branches.BOWEL, MESENTERY: Wall thickening and mucosal hyperenhancement involving the cecum, a sending colon and proximal transverse colon is unchanged and compatible with a colitis. Dilatation of colonic loops is slightly decreased. Diffuse dilatation of small bowel loops suggests a persistent ileus.BONES, SOFT TISSUES: Anterior abdominal wall mesh. Severe degenerative changes of the visualized spine.OTHER: No pneumatosis or pneumoperitoneum. Anasarca.PELVIS: FemaleUTERUS, ADNEXA: Atrophic/absent uterus.BLADDER: No significant abnormality noted.LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: See above.BONES, SOFT TISSUES: There infiltration of the posterior soft tissues with the foci of air which likely represents a cecal decubitus ulcer. These inflammatory changes extend to immediately adjacent to the coccyx, however no osseous destruction is evident.OTHER: No significant abnormality noted. | 1.Nonspecific colitis of the proximal colon with persistent ileus. No abscess or evidence of obstruction.2.Increased small bilateral pleural effusions with right basilar consolidation/atelectasis.3.Likely sacral decubitus ulcer with inflammatory changes extending to the coccyx. While there is no osseous destruction evident, osteomyelitis cannot be excluded. |
Generate impression based on findings. | 82 years, Male. Reason: Dobbhoff placement History: Dobbhoff placement Dobbhoff tube tip projects over the gastric antrum. Guidewire is still in place. Multiple surgical clips are noted in the pelvis. Nonobstructive bowel gas pattern. Residual contrast material from prior examination is noted within the colon. | Dobbhoff tube tip projects over the gastric antrum. |
Generate impression based on findings. | 55 years, Male. Reason: Looking for free air History: Sepsis Lung bases are clear. No pneumoperitoneum. Nonobstructive bowel gas pattern. | No evidence of pneumoperitoneum. |
Generate impression based on findings. | Male 74 years old Reason: eval for intraabdominal pathology History: abdominal pain Limited examination secondary to lack of intravenous contrast. Evaluation of solid organ and vascular pathology is suboptimal. Within these limitations, the following observations were made:ABDOMEN:LUNG BASES: Small bilateral pleural effusions, left greater than right. Left upper lobe pleural-based mass seen on previous exam is outside the field of view.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: Atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: No significant bowel wall thickening or dilatation. No evidence of obstruction. No intraperitoneal free air or pneumatosis. In the midabdomen, there is likely a duodenal diverticulum. Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: Degenerative changes of the visualized spine. OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Colonic diverticulosis without evidence of diverticulitis.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Limited examination secondary to lack of intravenous contrast making the evaluation of solid organ and vascular pathology suboptimal. Within these limitations, there is no acute abnormality to account for the patient's abdominal pain. 2.Small bilateral pleural effusions related to patient's known malignancy, unchanged. |
Generate impression based on findings. | Patient with pancreatic cancer. Reporting new onset shortness breath, tachycardia to 120, denying chest pain, cramping in legs, and extremely tired. PULMONARY ARTERIES: There is a new saddle pulmonary embolus with clot extending into multiple bilateral lobar pulmonary arteries including the right middle lobe, right lower lobe, and left upper and lower lobes. Clot continues to extend into multiple subsegmental arteries most prominently in the right lower lobe. The main pulmonary artery diameter is upper limits of normal measuring approximately 30 mm. There is straightening of the interventricular septum.LUNGS AND PLEURA: There is a peripherally located bubbly opacity within the inferior right upper lobe in the vascular distribution of a pulmonary embolus which is compatible with pulmonary hemorrhage/infarction. There is bibasilar atelectasis. No pleural effusion or pneumothorax is identified. MEDIASTINUM AND HILA: There is no significant pericardial effusion. There are scattered mediastinal lymph nodes but none of pathologic size by CT size criteria.CHEST WALL: A right chest port catheter terminates in the SVC. There are multilevel degenerative changes of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. There is expected mild intrahepatic pneumobilia and a partially imaged common bile duct stent. There are numerous ill-defined hypoattenuating lesions within the liver corresponding to known hepatic metastases. | 1. New saddle pulmonary embolus with large clot burden extending into all lobar pulmonary arteries with evidence of right heart strain. 2. New opacity in the inferior right upper lobe is compatible with hemorrhage/infarction. 3. Patient admitted through the emergency department. PULMONARY EMBOLISM: PE: YesChronicity: Acute.Multiplicity: Multiple.Most Proximal: Main.RV Strain: Positive. |
Generate impression based on findings. | 95 year-old female with aortic stenosis -- preop for TAVR for evaluation ABDOMEN:LUNG BASES: Moderate sized Left and small right pleural effusion again seen with left basilar atelectasis.LIVER, BILIARY TRACT: Pneumobilia again seen. Prior cholecystectomy. Within the limits of arterial phase images only, liver parenchyma shows no significant abnormalities, however without more delayed imaging, parenchyma is incompletely evaluated.SPLEEN: Calcified subcentimeter splenic artery aneurysm again seen unchanged. No parenchymal abnormalities seen.PANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: Subcentimeter benign appearing cortical cysts again seen without significant abnormality notedRETROPERITONEUM, LYMPH NODES: No retroperitoneal masses or significant adenopathy seen. CT angiogram: Diffuse atherosclerotic calcification and peripheral plaquing is seen throughout the aorta without aneurysmal dilatation or significant narrowing. The aorta bifurcates into widely patent common iliac arteries bilaterally. No significant narrowing is seen although mild tortuosity in both vessels is noted. Bilaterally normal bifurcations into internal and external iliac arteries with mild tortuosity is seen, without significant narrowing in the external iliac arteries. Diffuse atherosclerotic calcifications are seen in the common femoral arteries bilaterally which significantly narrow the lumens. Occlusion at the origin of the celiac axis is seen with reconstitution approximately 1.5 cm past its origin via collaterals with good peripheral runoff. Origin of the superior mesenteric artery appears normal. Atherosclerotic calcified plaques are seen the origin of the right renal artery but there does not seem to be significant narrowing. The origin of the left renal artery similarly shows peripheral plaquing but is patent. There is mesenteric artery is normal.Minimal cross-sectional measurements for the key aorta and iliac/femoral artery vessels are provided as follows:Aorta: 1.7 x 1.6 cmRight proximal common iliac artery: 0.9 x 1.0 cmRight proximal external iliac artery: 0.7 x 0.8 cmRight common femoral artery: 0.6 x 0.5 cm (series 5, image 294).Left proximal common iliac artery: 0.8 x 0.8 cmLeft proximal external iliac artery: 0.7 x 0.8 cmleft common femoral artery: 0.58 x 0.58 cm (series 5, image 302)left proximal superficial femoral artery: 0.6 x 0.6 cm BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:UTERUS, ADNEXA: Calcifications in uterus from fibroids small tumors -- no other significant abnormality seen.BLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: Postoperative changes seen. Old healed pubic rami fractures and diffuse degenerative changes not significantly different than prior examination.OTHER: No significant abnormality noted | Diffuse atherosclerotic changes in the aorta, common iliac and femoral arteries. Mild tortuosity is seen with substantial calcification and peripheral atherosclerotic plaques, greatest in the common femoral arteries bilaterally, which narrow arterial luminal diameters. See specific measurements above. |
Generate impression based on findings. | Six year old female with periumbilical abdominal pain, vomiting. Evaluate for obstruction or constipation.VIEW: Abdomen AP (one view) 2/24/2015 Moderate fecal burden. Nonobstructive bowel gas pattern. | Moderate fecal burden with no obstruction. |
Generate impression based on findings. | 13-year-old female status post fall, hip pain. Evaluate for fracture or avulsion.VIEWS: Pelvis AP (one views) 2/24/2015 Normal alignment. No soft tissue swelling or joint effusion. No fracture or dislocation. | Normal examination. |
Generate impression based on findings. | 50 years, Female. Reason: Placement of NG tube History: As above Central venous catheter tip is in the left atrium. NG tube side port projects over the proximal gastric body with tip in the fundus. Multiple surgical clips, staples, and suture material project over the right hemiabdomen. Dilated loops of air filled small bowel measuring up to 3.4 cm and large bowel measuring up to 8.4 cm. Note that the pelvis is excluded from the field-of-view. | Findings consistent with ileus type bowel gas pattern. NG tube tip projects over the gastric fundus. |
Generate impression based on findings. | 13 year old female tripped and fell on knee, pain. Evaluate for fractureVIEWS: Right knee AP, oblique, lateral (3 views) 2/24/2015 Normal alignment. No soft tissue swelling or joint effusion. No evidence of fracture or dislocation. | Normal examination. |
Generate impression based on findings. | 51 years, Male. Reason: kidney stone left History: stone No abnormal patient's to suggest nephrolithiasis. Nonobstructive bowel gas pattern. | No definite nephrolithiasis. |
Generate impression based on findings. | Reason: eval for shunt disruption, intrathoracic abscess History: shunt infection LUNGS AND PLEURA: No suspicious pulmonary nodules or masses. Mild basilar subsegmental atelectasis/scarring. No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is normal in size, without pericardial effusion. Mild coronary artery calcification.No mediastinal or hilar lymphadenopathy.CHEST WALL: Shunt catheter tubing extends down the right anterolateral chest wall, where it curls and terminates in the right axilla. In this region, there is a multiloculated, thin-walled low-density fluid collection. The largest component measures 4.1 x 3.5 cm (series 4, image 31).Multiple right-sided healed rib fractures. Mild degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. Several short segments of density tubular structures are present within the lumen of the colon (series 4, image 88), which may represent catheter tubing.Multiple hypodense renal lesions are partially visualized, incompletely characterized on this exam, including a higher density lesion measuring 20 x 18 mm (series 4, image 90).Status post splenectomy. | 1. Shunt tubing terminates in the axilla as it courses downward from the neck, with thin-walled, multiloculated, simple fluid collection near its termination point, compatible with a CSF collection.2. Short segments of possible catheter tubing identified within the lumen of the colon.3. Incompletely characterized 2cm left renal lesion.4. No acute cardiopulmonary abnormality.Findings discussed by the radiology resident on call with Dr Sicker at 4:15 AM. |
Generate impression based on findings. | 53 years, Male. Reason: Worsening abdominal pain, free air History: Worsening abdominal pain Examination is limited by patient body habitus. Nonobstructive bowel gas pattern with centralization of bowel loops compatible with ascites. Cholecystectomy clips project over the right quadrant. Basilar opacities may represent atelectasis. | Limited examination with nonobstructive bowel gas pattern. If there is continued clinical concern for pneumoperitoneum a left lateral decubitus radiograph can be obtained. |
Generate impression based on findings. | 66-year-old male that evaluate anatomy prior to mitral valve replacement. ABDOMEN:LUNG BASES: See chest CT report for complete details. No significant abnormality seen in lung bases.LIVER, BILIARY TRACT: Within limits of an arterial phase contrast image two the liver common no parenchymal abnormalities are seen come all the lack of more delayed images limits parenchymal evaluation. Gallbladder and biliary tract appear normal.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.CT ANGIOGRAM: Abdominal aorta is of normal caliber throughout its length without significant narrowing and no aneurysmal dilatation. Scattered mild peripheral atherosclerotic calcifications are seen. Minimal tortuosity aorta is seen. Origins of the celiac axis, superior mesenteric artery, bilateral renal arteries and inferior mesenteric artery are widely patent. Aorta has normal bifurcation into mildly tortuous common and external iliac arteries bilaterally without significant stenosis. Common and superficial femoral arteries show no significant narrowing or other abnormality.Representative axial bidimensional measurements of selected vascular sites are as follows:Midabdominal aorta (series 5, image 242): 2.2 x 2.2 cm.right proximal common iliac artery (series 402, image 2): 1.3 x 1.3 cmright proximal external iliac artery (series 402, image 3): 1.0 x 1.1 cmright common femoral artery (series 402, image 4) 1.0 x 1.1 cmproximal right superficial femoral artery (series 402, image 5): 0.9 x 0.9 cmProximal left common iliac artery (series 403, image 2): 1.5 x 1.5 cmproximal left external iliac artery (series 403, image 3): 1.2 x 1.2 cmleft common femoral artery (series 403, image 4) 0.2 x 1.2 cmleft superficial femoral artery (series 403, image 5) 0.8 x 0.9 cm.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1. CT arteriogram reveals minimal tortuosity of aorta and left common and external iliac artery (greater than right external iliac artery). Measurements of selected artery sites as above. 2. No significant narrowing or aneurysmal dilatation identified. 3. No other extravascular significant abnormality seen. |
Generate impression based on findings. | Right wrist injury with pain. Evaluate for fracture. There is diffuse soft tissue swelling. I see no underlying fracture. Moderate osteoarthritis affects the basilar joint and the triscaphe joint. Small densities within the periarticular soft tissues likely represent chondrocalcinosis. | Soft tissue swelling and degenerative arthritic changes without fracture evident. |
Generate impression based on findings. | No acute facial bone fracture is identified. There is right maxillary soft tissue subcutaneous stranding and hematoma. The temporomandibular joints are intact.No orbital fracture is identified. There is subtle dehiscence involving the cribriform plate, likely developmental. The globes are intact. There is no evidence of intraorbital hematoma or stranding.The visualized paranasal sinuses and mastoid air cells are clear. | Right malar soft tissue hematoma. No maxillofacial fractures. |
Generate impression based on findings. | 24 years, Male. Reason: s/p ventriculo-gallbladder shunt History: s/p ventriculo-gallbladder shunt Nonobstructive gas pattern. Two shunt catheters course along the right lateral chest wall in the subcutaneous tissues. The previously seen shunt has a distal tip that terminates in the subcutaneous tissues. There has been interval placement of a shunt that is coiled over the expected location of the gallbladder. Pigtail drainage catheter projects over the left flank. The tracheostomy, posterior fusion hardware, IVC filter are noted. G-tube noted with enteric contrast pooling in the stomach. Surgical clips project over the left hemipelvis. Thoracic osseous abnormalities again noted. | New shunt courses along the right lateral chest wall and is coiled over the expected location of the gallbladder. |
Generate impression based on findings. | Male 78 years old Reason: r/o R hip dislocation History: R leg internally rotated, pain 10/10, recent hip hemi-arthroplasty 2/7/15. We have two views of the right hip showing hardware components of a right bipolar hemiarthroplasty device situated in near anatomic alignment. We see no fracture or dislocation. Note is made of skin staples overlying the upper thigh. | Right hip hemiarthroplasty without dislocation. |
Generate impression based on findings. | Male 68 years old Reason: eval shunt placement History: shunt protrusion. Again seen is an intracranial shunt with its tip coiling and terminating in the right axilla. Note is made of old healed fractures of the right sixth, seventh, eighth, and ninth ribs. Surgical clips, suture material, and possibly a fragment of shunt tubing are seen in the upper abdomen. Please refer to subsequent CT report for further details. | Shunt tubing terminating in the right axilla and other findings as described above. |
Generate impression based on findings. | Male; 35 years old. Reason: Known bilateral adrenal masses, most recent scan one year ago, would like to assess for interval growth. ABDOMEN:LUNG BASES: No significant abnormality notedLIVER, BILIARY TRACT: Hypodense lesion in the inferior right liver measures 2.4 x 1.3 cm and demonstrates peripheral discontinuous nodular enhancement with eventual uniform contrast filling on delayed phase images (series 4, image 177). Findings are compatible with hemangioma. No suspicious hepatic lesions or biliary ductal dilatation.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: Innumerable confluent hypodense lesions are noted throughout both adrenal glands. These lesions measure water density (1 HU) on precontrast images and demonstrate mild enhancement (42 HU) with washout on delayed images (14 HU). Based on representative ROI values above, relative washout is 67%. Findings are compatible with numerous adenomas. These lesions are not significantly changed from previous CT based on comparative ROI measurements of -3 HU (precontrast), 51 HU (postcontrast), and 18 HU (delayed). KIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: No significant abnormality noted.BONES, SOFT TISSUES: No significant abnormality noted.OTHER: No significant abnormality noted.PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: No significant abnormality notedBONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Numerous bilateral adrenal adenomas, consistent with adrenal adenomatosis and not significantly changed since March 2014. Correlate for signs of Carnie complex.2.Inferior right liver hemangioma. |
Generate impression based on findings. | Newly diagnosed high grade prostate cancer Foci of increased activity are noted within the left maxillary/ethmoid sinus region as well as in the left frontal calvarium which are nonspecific.Single focus of increased activity noted in the right lower rib is nonspecific but more likely represents a site of fracture. Degenerative changes are noted about the shoulders and knees bilaterally. | 1.Foci of increased activity within the left maxillary/ethmoid sinus region and left frontal calvarium are nonspecific and can be further evaluated with head CT. 2.Nonspecific right lower rib focus likely represents a site of fracture. |
Generate impression based on findings. | Rheumatoid arthritis. Pain RIGHT HAND: Minimal osteoarthritis affects the distal interphalangeal joints. Tiny osteophytes at the second metacarpophalangeal joint are noted, without erosions or other specific features of inflammatory arthritis.LEFT HAND: Minimal osteoarthritis affects the distal interphalangeal joints. Tiny osteophytes at the metacarpophalangeal joints are noted, without erosions or other specific features of inflammatory arthritis.RIGHT ANKLE/FOOT: Three views of the right ankle demonstrate no erosions or specific features of inflammatory arthritis. Three views of the right foot demonstrate small midfoot osteophytes, indicating mild osteoarthritis. There is a mild pes planovalgus deformity. We see no erosions or specific features of inflammatory arthritis.LEFT ANKLE/FOOT: Three views of the left ankle demonstrate no erosions or specific features of inflammatory arthritis. Three views of the left foot demonstrate small midfoot osteophytes, indicating mild osteoarthritis. There is perhaps a mild flatfoot deformity. We see no erosions or specific features of inflammatory arthritis. | Mild degenerative arthritic changes, without radiographic features of rheumatoid arthritis. |
Generate impression based on findings. | Pleuritic chest pain, shortness of breath. Evaluate for PE. PULMONARY ARTERIES: Technically adequate study to the segmental level without evidence of an acute pulmonary embolus. The main pulmonary artery is slightly enlarged measuring approximately 31 mm in diameter which may be seen in the setting of pulmonary arterial hypertension.LUNGS AND PLEURA: There is no focal consolidation, pleural effusion or pneumothorax. There is mild apical predominant centrilobular emphysema. In the lung bases there are thin-walled lucencies which could represent focal emphysema or cysts. A subpleural right lower lobe 3-mm pulmonary micronodule is nonspecific (image 90, series 9), but the configuration suggests a small lymph node. A left lower lobe calcified granuloma is noted. No conclusive coronary artery calcifications are identified on this non-gated examination.MEDIASTINUM AND HILA: There is no significant pericardial effusion. There is no mediastinal or hilar lymphadenopathy. Calcified left hilar lymph nodes is suggestive of prior granulomatous disease. There is no evidence of right heart strain. CHEST WALL: There are mild multilevel degenerative changes of the spine. UPPER ABDOMEN: Absence of enteric contrast material markedly limits sensitivity for abdominal pathology. Punctate hepatic and splenic calcifications are compatible with prior granulomatous disease. A subcentimeter left hepatic lobe hypodensity is too small to characterize. | 1. No evidence of an acute pulmonary embolus. 2. Mild centrilobular emphysema. In the lung bases there are thin-walled lucencies which could represent focal emphysema or cysts; anatomic detail is limited by exam noise. 3. Right lower lobe pulmonary micronodule is probably benign; a follow up CT in 12 months is suggested in high risk individuals, i.e. smokers. PULMONARY EMBOLISM: PE: NoChronicity: Not applicable.Multiplicity: Not applicable.Most Proximal: Not applicable.RV Strain: Not applicable. |
Generate impression based on findings. | 26 year-old female history of MVC. There is slight straightening of the cervical spine. There is no acute fracture or subluxation. Vertebral body heights and intervertebral disc spaces are preserved. The prevertebral soft tissues are within normal limits. The airway is patent. The imaged portions of the lung apices are unremarkable. | 1.Slight straightening of the cervical spine which may be secondary to patient positioning or muscle spasm, but otherwise no acute fracture or subluxation.2.We cannot exclude the possibility of a soft tissue injury such as interspinous ligaments, anterior and posterior longitudinal ligaments as well as muscles by CT. If patient care warrants further imaging, an MRI may be obtained. |
Generate impression based on findings. | Clinical question: Evaluate right frontal mass. Signs and symptoms: Right frontal mass. Pre-and post enhanced head CT:Examination demonstrate a rather well demarcated slightly higher density mass abutting the right aspect of falx and inner table of the skull in the right anterior/inferior frontal region. It demonstrate uniform intense enhancement. This lesion measures approximately at 30 x 30 x 37 mm in size. There is evidence of surrounding vasogenic edema and subtle mass effect on the right frontal and and corpus callosum. Findings is consistent with an extra axial meningioma. There is loculated tiny foci of tumor extension through the falx to the left side with resultant subtle effacement of subarachnoid space however without any appreciable mass effect on the left frontal lobe or vasogenic edema.In addition examination demonstrate a second extra-axial well demarcated enhancing mass in the left cavernous sinus with resultant expansion of the sinus. The findings also extends to the left petroclinoid ligament and further posteriorly into the left upper cerebellopontine angle cistern and across the midline along the dorsal aspect of dorsum sella and clivus to the right. This finding is consistent with a second meningioma and measures maximum of 24 x 24 mm in transaxial dimensions. The prepontine component of tumor has large contact with the distal basilar artery however without suggestion of encasement on this study.Examination demonstrates minimal changes of aging determinate the small vessel ischemic strokes. There is mild prominence of lateral ventricles which may be within normal range for patient's stated age of 90.Cortical sulci and CSF cisterns remain patent and unremarkable.Calvarium and soft tissues of the scalp are unremarkable.Images through the orbits demonstrate mild prominence of left superior ophthalmic vein which could be as a result of mass in the left cavernous sinus. Blastic vessels and paranasal sinuses remain well pneumatized. | 1.Right anterior/inferior paramedian frontal meningioma measuring 30 x 30 x 37-mm with mild surrounding vasogenic edema and regional mass-effect.2.Meningioma left cavernous sinus measuring at approximately 24 mm in transaxial dimensions with extension into the left upper cerebellopontine angle cistern and prepontine cistern as detailed. This meningioma is in contact with the basilar artery however without suggestion of encasement on this study.3.Mild age indeterminate small vessel ischemic stroke is noted. |
Generate impression based on findings. | 8-month-old female with complex history now febrile. Evaluate for pneumoniaVIEW: Chest AP (one view) 2/24/2015 22:40 Left-sided central venous catheter tip in the right atrium. Enteric tube tip at third portion of the duodenum. Partially visualized left percutaneous biliary drain tip in the right upper quadrant. IVC stents unchanged.Cardiothymic silhouette is normal. Persistent low lung volumes with bibasilar atelectasis and no focal pulmonary opacity. No pleural effusion or pneumothorax. | No evidence of pneumonia as clinically questioned. |
Generate impression based on findings. | The ventricles and sulci are within normal limits. There is no midline shift or mass effect. There is persistent moderate diffuse cerebral white matter hypoattenuation which may represent chronic small vessel ischemic changes. There is no intracranial hemorrhage, within the limitations of only postcontrast imaging. There are no areas of pathological enhancement. There is no extraaxial fluid collection. There are small scattered left maxillary sinus mucosal retention cysts. There are few opacified left mastoid air cells The remainder of the visualized portions of the paranasal sinuses and mastoids/middle ears are grossly clear. NECK | 1. Redemonstration of extensive post treatment changes within the neck including mild diffuse thickening of the visualized esophageal wall. No evidence of focal mass to suggest recurrence or cervical lymphadenopathy.2. No intracranial metastases. Probable chronic small vessel ischemic changes. |
Generate impression based on findings. | R/O avascular necrosis History: 20 yo M with sickle cell, with bilateral hip pain RIGHT HIP: The bones are overall slightly dense, compatible with the history of sickle cell disease. Additional density in the femoral head may represent avascular necrosis or simply overlap of bony structures. We see no subchondral fracture or articular surface collapse.LEFT HIP: The bones are overall slightly dense, compatible with the history of sickle cell disease. Additional density in the femoral head may represent avascular necrosis or simply overlap of bony structures. We see no subchondral fracture or articular surface collapse. | Bony changes of sickle cell disease with equivocal findings of avascular necrosis, without subchondral fracture or articular surface collapse. If further imaging evaluation is clinically warranted, MRI may be considered. |
Generate impression based on findings. | Ms. Morgan is a 33 year old female presenting for a palpable lump in the right breast. However, on examination today, patient does not palpate any abnormality. History of prior right breast surgical biopsy. 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. There is a 4-mm cluster of amorphous calcifications identified in the left superior breast, which persists on the spot magnification views. Distortion in the right breast is compatible with prior surgery. There is no suspicious mass, suspicious microcalcifications or areas of architectural distortion identified in the right breast. | 4-mm cluster of amorphous calcifications in the left breast. Presumed post biopsy distortion in the right breast. Attempts to obtain patient's prior mammograms will be made in order to confirm stability of these findings. If not possible, than a stereotactic biopsy of the left breast calcifications is recommended for further histologic evaluation.A release form has been faxed to the outside institution to obtain the prior mammograms.BIRADS: 0 - INCOMPLETE; Need additional imaging evaluationRECOMMENDATION: O - Old Study For Comparison. |
Generate impression based on findings. | Male 32 years old Reason: eval fracture History: fall on ice. There is soft tissue swelling about the middle phalanx of the middle finger. We see no fracture or malalignment. | Soft tissue swelling without fracture. |
Generate impression based on findings. | Male 51 years old Reason: eval fracture History: fell off scaffolding, no deformity, diffuse tenderness. We see no acute fracture. A small ossicle just above the left T12 costovertebral junction appears chronic in etiology and is of doubtful current clinical significance. The thoracic vertebral body heights are preserved. Please refer to spine CT report for further details. | No acute fracture; other findings as above. |
Generate impression based on findings. | Status post resection of olfactory groove meningioma There are immediate postsurgical changes of redo bifrontal craniotomy for resection of residual extra-axial mass. There are expected postsurgical changes including air and blood products within the surgical bed involving the bilateral frontal lobes extending to the anterior cranial fossa. There is hypodensity consistent with edema within the bifrontal lobes, which is increased since 2/18/2015. There is mass effect with effacement of the bilateral frontal horns and deformity involving the callosal genu which was present on prior. There is no significant midline shift. No transtentorial herniation. No hydrocephalus. Osseous remodeling involving the anterior skull base and and paraclinoid region again noted. Exenteration of the frontal sinuses again noted. | 1. Expected postsurgical changes related to re-resection of residual extra-axial bifrontal mass with small amount of hemorrhage in the resection bed. There is mass effect on the bilateral frontal lobes, lateral ventricles, and callosal genu which was present on prior. No significant midline shift or transtentorial herniation. 2. MRI can better assess for residual tumor. |
Generate impression based on findings. | History of subarachnoid hemorrhage and ventriculomegaly. There has been interval resolution of the subarachnoid hemorrhage. Likewise, the intraventricular hemorrhage has essentially resolved. There is no evidence of acute intracranial hemorrhage. There is persistent dilatation of the entire ventricular system, with a right transfrontal ventricular shunt catheter in position. There are unchanged areas of hypoattenuation involving the left inferior frontal gyrus, a portion of the left superior temporal gyrus extending into the left supramarginal gyrus, and the inferior medial aspects of the frontal lobes bilaterally. There is a stent in the distal left internal carotid artery. The imaged portions of the paranasal sinuses and mastoid air cells are clear. The imaged portions of the orbits are unremarkable. | 1.Interval resolution of the subarachnoid and intraventricular hemorrhage without evidence of new intracranial hemorrhage. 2.No significant change in the ventriculomegaly with ventricular shunt in position.3.Multiple foci of encephalomalacia likely related to infarcts.4.Distal left internal carotid artery stent. |
Generate impression based on findings. | Female 25 years old Reason: eval for abscess History: swelling, erythema. Again seen is a reconstruction of the proximal and mid humerus by a longstem endoprostheses device. There is lateral positioning of the head of the prosthesis in relation to the glenoid, but this is unchanged from the prior study. There is minimal lucency about the distal stem of the prosthesis and while we cannot entirely exclude the possibility of mild loosening, this is not necessarily an abnormal finding. The musculature appears atrophic. Surgical clips and streaky calcifications within the anterior soft tissues are unchanged. We see no specific radiographic findings to suggest an abscess. | Postoperative changes as described above. No specific radiographic findings to suggest abscess. |
Generate impression based on findings. | There is straightening of the cervical spine which may reflect patient positioning or muscle spasm. Otherwise, alignment is within normal limits without fracture. Vertebral body heights and disk spaces are preserved. There is no significant central canal or neuroforaminal compromise. There is mild reticulation of the posterior neck subcutaneous fat. Otherwise, paraspinal soft tissues appear unremarkable. The imaged portions of the lung apices are within normal limits. | No fracture or other significant abnormalities to account for the patient's pain. |
Generate impression based on findings. | Male 56 years old Reason: colon cancer compare to last CT \T\ measure 1) RLL nodule and 2) LUL nodule History: post 2 cycles of chemo CHEST:LUNGS AND PLEURA: Reference left upper lobe nodule is slightly increased in size and measures 1.4 x 1.2 cm (series 4, image 51), previously 1.2 x 1.1 cm.Reference right lower lobe nodule is increased in size and measures 2.7 x 2.5 cm, previously 2.5 x 2.1 cm.Multiple additional bilateral non-reference pulmonary nodules are again seen, some of which are stable in size, others of which have increased in size. No pleural effusion or pneumothorax.MEDIASTINUM AND HILA: Heart size is normal without pericardial effusion. No mediastinal or hilar lymphadenopathy. Moderate coronary artery calcifications. Right chest wall port with catheter tip at the cavoatrial junction. Atherosclerotic calcifications of the thoracic aorta. And aCHEST WALL: Right chest wall port.ABDOMEN: Limited exam secondary to lack of intravenous and oral contrast. Lack of intravenous contrast makes evaluation of solid organ and vascular pathology suboptimal. Lack of oral contrast makes evaluation of bowel pathology suboptimal. Within these limitations, the following observations were made:LIVER, BILIARY TRACT: Two hypoattenuating foci within the residual liver are stable and likely represent hepatic cysts. Postsurgical changes from prior right hepatectomy and cholecystectomy.SPLEEN: No significant abnormality notedPANCREAS: No significant abnormality notedADRENAL GLANDS: No significant abnormality notedKIDNEYS, URETERS: No significant abnormality notedRETROPERITONEUM, LYMPH NODES: Atherosclerotic calcifications of the abdominal aorta and its branches.BOWEL, MESENTERY: Subtle fat stranding in the right upper quadrant which is stable and may be related to postsurgical changes from prior hepatectomy. No definite signs of carcinomatosis.BONES, SOFT TISSUES: Mild leftward curvature of the lower thoracic spine.OTHER: No significant abnormality notedPELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical changes in the region of the sigmoid colon. No evidence of bowel wall thickening or obstruction.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Limited examination secondary to lack of intravenous and oral contrast. Within these limitations, there is interval worsening of pulmonary metastatic disease.2.Stable disease in the abdomen and pelvis. |
Generate impression based on findings. | Pt with history of renal transplant, smoking, remote breast ca w/ recent CT PE that showed lung masses and scattered nodules concerning for infection vs malignancy. Now s/p 2 days of broad spectrum antibiotics with no improvement in breathing. Please compare for improvement. LUNGS AND PLEURA: Patchy areas of tree in bud and nodular opacities within the right upper, right lower, left upper, and the left lower lobes. A masslike area of dense consolidation within the left lower lobe has increased in size now measuring approximately 4.3 x 6.4 cm (image 63, series 4), previously 3.0 x 3.4 cm. This is noted to contain internal lucencies and this wedge-shaped in appearance; an infarct either from embolism or angioinvasive fungal infection may produce this appearance. 16mm nodule in the lingula of difficult due to characterize to to motion in this area and could be due to hematogenous spread of infection. There is a trace left pleural effusion. No pneumothorax is noted. MEDIASTINUM AND HILA: No significant pericardial effusion or lymphadenopathy. An aortic valve prosthesis is noted. Severe coronary artery and aortic arch calcifications.CHEST WALL: Status post right mastectomy. Median sternotomy hardware is noted. There are multilevel degenerative changes of the thoracic spine. The bone density appears high suggestive of renal osteodystrophy.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. | Interval increase in size of a left lower lobe masslike consolidation which may represent infarction due to angioinvasive aspergillosis or other agents. Additional pulmonary opacities are otherwise without significant change and have an appearance more suggestive of endobronchial spread of infection with the exception of lesion in the right middle lobe which appears hematogenous. |
Generate impression based on findings. | 21 year-old female with history of postpartum headache. Evaluate for venous sinus thrombosis. Head: There is no evidence of edema, intracranial hemorrhage or mass. The grey-white matter differentiation is preserved. The ventricles are normal in size and configuration. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. The skull and scalp soft tissues are unremarkable. Venogram: There is slight irregularity and attenuation of the left transverse sinus proximal to the sigmoid sinus appearing similar to prior, likely representing incomplete recanalization or congenital asymmetric anatomy (hypoplastic left transverse dural sinus). A linear filling defect is present at the torcula, but this is also likely chronic/congenital in etiology. Adequate flow is maintained bilaterally. There is no evidence of acute cortical vein or dural venous thrombosis. | 1. No evidence of venous congestive encephalopathy.2. No evidence of acute dural venous thrombosis. |
Generate impression based on findings. | 52 year old woman with history of left breast papilloma, lumpectomy scheduled 2/25/15 On review of the prior studies, there is a lobulated mass in the left breast at 6:00, posterior depth with a biopsy clip in place.The procedure, risks including bleeding, mistargeting and infection, and benefits of needle-wire localization were discussed with the patient. Questions were answered. Consent was obtained both verbally and in writing. The time out form was completed to confirm patient identity and site of procedure. The left breast was placed in an alphanumeric grid using inferior to superior approach. When the target was positioned in the aperture of the grid, the skin was cleansed with chlorhexidine. Local anesthesia was obtained using 2% Lidocaine. Using coordinates from the grid, a 5 cm Kopans needle was placed through the lesion. On orthogonal mammography, adequate positioning of the needle was confirmed after adjusting depth so the needle tip was approximately 2cm deep to the center of the target. A spring wire was then deployed. Repeat two view orthogonal mammograms reveal the spring wire to be in good position with the biopsy clip along the inferior aspect of the reinforced section of wire. The mammogram was annotated and reviewed with Dr. Jaskowiak prior to the patient's procedure. Patient tolerated the procedure well and was sent to the holding area in stable condition. Drs. Patel and Schacht performed the procedure under direct supervision of Dr. Schacht, who was present during the procedure at all times.Orthogonal digital specimen radiographs revealed the mass and clip and spring wire to be within the specimen. | Successful needle localization of the left breast mass.BIRADS: 4 - Suspicious Abnormality.RECOMMENDATION: X - No Letter. |
Generate impression based on findings. | Clinical question: Follow-up on subarachnoid hemorrhage. Signs and symptoms: Resuming Plavix. Nonenhanced head CT:There is trace residual subarachnoid hemorrhage in the right sylvian fissure. There is complete resolution of the small hemorrhage in the dependent occipital horns since prior exam.Trace residual subarachnoid hemorrhage is also noted in high convexity right frontal region.Findings suggestive of mild age indeterminate small vessel ischemic strokes is noted. The cortical sulci, ventricular system and cerebral cortex is unremarkable.Unremarkable calvarium and soft tissues of the scalp.Unremarkable orbits, paranasal sinuses and mastoid air cells. | 1.No acute new finding since prior exam. 2.Interval significant decreased subarachnoid hemorrhage with trace residual as detailed.3.Stable exam otherwise. |
Generate impression based on findings. | 1-year-old male with abdominal distention, evaluate bowel gasVIEW: Abdomen AP (one view) 2/24/151 16:36 A moderate two large colonic stool burden is noted in the right hemiabdomen. A small amount of gas is seen in the distal small bowel without dilated loops or other evidence of obstruction. No bowel wall pneumatosis, portal venous gas or evidence of free intraperitoneal air. | Moderate to large colonic stool burden without evidence of obstruction. |
Generate impression based on findings. | 52 year old woman with history of abnormal mammograms and benign biopsy of the right breast. Three standard views of both breasts were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is composed of scattered fibroglandular density, unchanged in pattern and distribution. Multiple circumscribed masses in the right upper outer breast appear similar in size and unchanged in benign morphology. These correlate to cysts seen on prior ultrasound in 2013. Scar marker noted over the right breast.Multiple circumscribed masses in the left upper inner breast also appears stable in size and morphology. No new dominant mass, suspicious microcalcifications, or areas of architectural distortion are seen in either breast. Benign appearing lymph nodes are projected over both axillae. | Benign bilateral masses, many previously seen to be cysts but no mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral diagnostic mammogram is recommended annually given the complex mammographic findings. Results and recommendation were discussed with the patient. BIRADS: 2 - Benign finding.RECOMMENDATION: ND - Diagnostic Mammogram. |
Generate impression based on findings. | Female 18 years old Reason: mid-epigastric pain, biliary colic in nature, evaluate biliary tree History: same LIVER: 18.2 cm in length. Normal echotexture. No focal lesions.Flow in the portal vein is hepatopedal, peak velocity .3 m/sec.GALLBLADDER, BILIARY TRACT: Cholelithiasis. Gallbladder is not distended although the wall is upper normal 3 mm in thickness. No pericholecystic fluid. No tenderness to compression.No intrahepatic or extrahepatic biliary dilatation. Common bile duct measured .2 cm in diameter.PANCREAS: No significant abnormalities noted.RIGHT KIDNEY: 11.1 cm in length.OTHER: Left kidney 10.1-cm in length. Prominent renal pelvis no caliectasis.Spleen 9.3 cm in length.No evidence of ascites. | Cholelithiasis. No evidence of cholecystitis. |
Generate impression based on findings. | 12-year-old male, right knee pain and swellingVIEWS: Left knee, AP, oblique, and lateral (3 views) 2/24/15 17:26 Soft tissue swelling is present anterior to the patellar ligament. There may be a small joint effusion. Alignment is anatomic. No fracture or joint effusion. | Soft tissue swelling adjacent to patellar ligament and possible small joint effusion without fracture or dislocation. |
Generate impression based on findings. | Frontal sinus: The frontal sinus and frontoethmoidal recesses are clear.Anterior ethmoids: There is scattered trace mucosal thickening in the anterior ethmoids.Maxillary sinuses: There is trace mucosal thickening in the maxillary sinuses, with a tiny mucosal retention cyst in the left. The ostiomeatal units are clear, although the left infundibulum is slightly narrowed due to focal mucosal thickening.Posterior ethmoids: The posterior ethmoid air cells are clear.Sphenoid sinus: The sphenoid sinuses are clear. There is mild-moderate leftward nasal septal deviation with a 4-mm leftward directed bony spur which abuts the left inferior turbinate. There are bilateral concha bullosa, The nasal cavity is clear.The lamina papyracea are intact. The roof of the ethmoids is slightly higher on the right. There is a partial residual root in the left maxilla. | No CT evidence of acute or chronic sinusitis. Minimal scattered trace mucosal thickening as noted above. Mild to moderate leftward nasal septal deviation. |
Generate impression based on findings. | Male 62 years old Reason: baseline exam for heart transplant evaluation. LIVER: 14.3 cm in length. Coarse heterogeneous echotexture of the liver. No evidence of nodularity to the liver surface to suggest cirrhosis. No focal lesions.Flow in the portal vein is hepatopedal, peak velocity .2 m/sec.GALLBLADDER, BILIARY TRACT: No evidence of cholelithiasis. No intrahepatic or extrahepatic biliary dilatation. Common bile duct measures .3 cm in diameter.PANCREAS: No significant abnormality noted.SPLEEN: Spleen 9.6 cm length.KIDNEYS: 9.7 cm in length. Normal echogenicity. No hydronephrosis hydroureter. Normal blood flow on limited color Doppler imaging. ABDOMINAL AORTA: Mid abdominal aorta diameter 1.5-cm x 1.7 x 1.6 cmINFERIOR VENA CAVA: No significant abnormality noted.OTHER: Left kidney 9.3 cm in length. No hydronephrosis. Normal blood flow and limited color Doppler imaging.No evidence of ascites. | Coarse liver texture. No definitive cirrhotic morphology. |
Generate impression based on findings. | FeverVIEW: Chest AP ET tube, NG tube, right PICC and posterior spinal fusion rods again noted. Cardiothymic silhouette normal. Left lower lobe opacity unchanged. Probable small left pleural effusion. Right lung atelectasis improved in the interval. | Left lower lobe opacity unchanged. |
Generate impression based on findings. | Reason: 77M s/p kidney transplant 2001 p/w acute leukemia History: acute leukemia LUNGS AND PLEURA: Scattered benign-appearing nodules, some calcified. No suspicious pulmonary nodules or masses.Mild basilar scarring, with traction bronchiectasis. Moderate dependent atelectasis.No focal airspace consolidation. No pleural effusions.MEDIASTINUM AND HILA: The heart is mildly enlarged, without pericardial effusion. Severe coronary artery calcification.No mediastinal or hilar lymphadenopathy.Small hiatal herniaCHEST WALL: Degenerative disease of the thoracic spine.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. Mild splenomegaly. | Mild basilar pulmonary scarring and traction bronchiectasis, without other acute abnormality. |
Generate impression based on findings. | Patient with pulmonary M. abscessus who is failing therapy. Productive cough. LUNGS AND PLEURA: There is upper lobe predominant bronchial wall thickening and bronchiectasis with extensive mucus plugging, increased from the prior exam. There is significantly increased upper lobe predominant tree in bud opacities which are more confluent within the anterior left upper lobe and superior left lower lobe. A scarlike nodular opacity in the left upper lobe has not significantly changed since a CT study on 5/2/2014. No pleural effusion or pneumothorax is identified. MEDIASTINUM AND HILA: The heart size is normal. There is no pericardial effusion. A pretracheal lymph node has increased in size measuring 11 mm in the short axis (image 26, series 3), previously 9 mm. There is no definite hilar lymphadenopathy or coronary artery calcifications. CHEST WALL: No significant abnormality noted.UPPER ABDOMEN: Absence of IV and enteric contrast material limits sensitivity for abdominal pathology. There is a cirrhotic morphology of the liver and the spleen is enlarged. Interval resolution of perihepatic ascites within the visualized abdomen. | 1. Bilateral upper lobe bronchiectasis with mucous plugging is compatible with history of cystic fibrosis. 2. Worsening upper lobe predominant tree-in-bud opacities is consistent with superinfection from atypical bacteria such as mycobacterium. |
Generate impression based on findings. | 17-day-old male, on HFOVVIEW: Chest AP (one view) 2/25/14 4:29 Right central venous catheter tip extends to the cavoatrial junction. ETT is below the thoracic inlet, above the carina. NG tube extends to the stomach.The cardiothymic silhouette is upper limits of normal. Extensive bilateral pulmonary opacities with slight improvement involving the lingula. Round lucencies at the lung bases may represent interstitial emphysema. No pneumothorax. | Extensive bilateral pulmonary opacities with round lucencies at the lung bases which may represent interstitial emphysema. No pneumothorax. |
Generate impression based on findings. | 4-month-old female with crackles, tachypnea and desaturation. Evaluate for pneumonia.VIEW: Chest AP (one view) 2/25/2015 1:54 Left-sided aortic arch, cardiac apex and stomach. Cardiothymic silhouette is normal. Peribronchial thickening with linear band like opacity in the right mid lung and bilateral lung bases likely atelectasis. No pleural effusion or pneumothorax. | Reactive airway disease or bronchiolitis pattern. |
Generate impression based on findings. | 17-day-old male on HFOVVIEW: Chest AP (one view) 2/24/15 18:18 ETT tip is at the thoracic inlet. NG tube tip in the stomach. Right central venous catheter tip at the cavoatrial junction.The cardiothymic silhouette is upper limits of normal. Diffuse bilateral pulmonary opacities are again noted without pneumothorax. | Diffuse bilateral pulmonary opacities without significant interval change. No pneumothorax. |
Generate impression based on findings. | Male; 32 years old. Reason: RLQ pain s/p multiple surgeries including parastomal hernia repair and ventral hernia repair (7/28/14) 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: Unchanged nonobstructive 1.3 cm calculus in the right renal pelvis (series 3, image 54), with mild stable associated right renal pelvic and proximal ureteral wall thickening. RETROPERITONEUM, LYMPH NODES: No significant abnormality noted.BOWEL, MESENTERY: Postsurgical changes status post ventral hernia and right lower quadrant parastomal hernia repair. Several bowel loops in the right lower quadrant appear to be adhesed to the anterior abdominal wall, best seen on series 3, image 87 and sagittal series 80297, image 36. Left lower quadrant ostomy is noted. No evidence of bowel obstruction, mesenteric inflammation, or free air.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No drainable fluid collection or free fluid. PELVIS:PROSTATE, SEMINAL VESICLES: No significant abnormality notedBLADDER: No significant abnormality notedLYMPH NODES: No significant abnormality notedBOWEL, MESENTERY: Postsurgical changes status post ventral hernia and right lower quadrant parastomal hernia repair. Several bowel loops in the right lower quadrant appear to be adhesed to the anterior abdominal wall, best seen on series 3, image 87 and sagittal series 80297, image 36. Left lower quadrant ostomy is noted. No evidence of bowel obstruction, mesenteric inflammation, or free air.BONES, SOFT TISSUES: No significant abnormality notedOTHER: No significant abnormality noted | 1.Postsurgical changes s/p hernia repairs with nonobstructive adhesions in the right lower quadrant that may explain the patient's symptoms.2.Unchanged right renal pelvic calculus and associated chronic changes as described above. |
Generate impression based on findings. | Pain RIGHT KNEE: Severe osteoarthritis affects the right knee with bone on bone apposition at the medial tibiofemoral compartment. There is mild varus deformity. These findings appear to have slightly progressed when compared to the prior study. Small joint effusion is present.LEFT KNEE: Severe osteoarthritis affects the left knee with bone on bone apposition at the medial tibiofemoral compartment. There is mild varus deformity. These findings appear to have slightly progressed when compared to the prior study. Small joint effusion is present with calcification in the suprapatellar pouch representing a loose body. | Severe osteoarthritis |
Generate impression based on findings. | 59-year-old recalled from screening for a new mass in the right breast. An ML view, CC view and multiple spot compression views of the right breast were performed digitally and reviewed with the aid of R2 CAD 9.3. The breast parenchyma is almost entirely fatty, unchanged in pattern and distribution. The finding from screening mammography has undergone interval decrease in size and is now fat density. This is compatible with a small oil cyst. An additional focal asymmetry is seen more centrally in the right upper outer quadrant. This largely dispersed with spot compression, more compatible with a focal area of parenchyma. No suspicious microcalcifications or areas of architectural distortion in the right breast. ULTRASOUND | Benign right breast oil cysts. No mammographic evidence of malignancy. As long as the patient's physical examination remains normal, bilateral screening mammogram is recommended annually, due for this patient in November 2015. Results and recommendation were discussed with the patient.BIRADS: 2 - Benign finding.RECOMMENDATION: NS - Screening Mammogram. |
Generate impression based on findings. | Female 26 years old Reason: eval fracture History: L TMJ tenderness s/p MVA . We see no fracture. The temporomandibular joint alignment is within normal limits. A linear lucency overlying the right mandibular angle is likely artifactual. | No fracture, dislocation, or other findings to account for patient's temporomandibular joint tenderness. |
Generate impression based on findings. | Male 85 years old; Reason: s/p right distal femur replacement, evaluate for loosening/hardware complications Two views of the right femur and two views of the right knee demonstrate reconstruction of the distal femur with a long stem endoprosthesis device. Heterotopic bone formation along the distal femur appears similar to that seen on the prior study. We see no specific radiographic features of loosening or other findings to suggest hardware complication.Moderate osteoarthritis affects the right hip. | Right femur reconstruction without evidence of acute complication. |
Generate impression based on findings. | Male 41 years old Reason: R thumb lack of IP flexion History: as above mallet finger. We have 3 views of the right thumb. We see no fracture or malalignment. | No fracture or other findings to account for patient's symptoms. |
Generate impression based on findings. | Left ankle fracture Again seen is an oblique fracture through the distal fibula extending to the tibiotalar joint with approximately 3 mm of lateral displacement of the distal fracture fragment, appearing similar to that seen on the prior study. On the oblique view, the fracture appears slightly less distinct, which may reflect some interval healing, however this is equivocal. A minimally displaced posterior malleolus fracture appears similar to that seen on the prior study. A tiny ossicle distal to the medial malleolus may represent a tiny avulsion fracture fragment as well. | Ankle fractures, as described above, appearing similar to the prior study, though there may be slight interval healing of the fibular fracture. |
Generate impression based on findings. | Reason: mets lung cancer. s/p 2 cycles of ABT-7-- + Docetaxel. Pls c/w previous study and evaluate tx response. History: lung ca LUNGS AND PLEURA: Right upper lobe spiculated subpleural nodule is decreased in size, now measuring 2.3 x 2.0 x 3.5 cm (series 7, image 34; coronal image 21), previously measuring 3.3 x 3.0 x 4.2 cm. The central portion of the mass is again predominantly low density, likely due to necrosis, with a new small focus of air within the nodule. No additional suspicious pulmonary nodules or masses.No new focal air space 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: Multiple healed left rib fractures.UPPER ABDOMEN: Absence of enteric contrast material limits sensitivity for abdominal pathology. No significant abnormality noted. See same day CT abdomen pelvis for additional details. | Interval decrease in size of a right upper lobe spiculated subpleural nodule, with persistent central necrosis and a new focus of gas within the lesion. Findings consistent with response to treatment. No new sites of disease. |
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